title: Umbilical stalk elevation technique for safer Veress needle insertion in obese patients: a case-control study.
abstract: OBJECTIVE
  The purpose of this retrospective study was to compare our umbilical stalk elevation (USE) technique with the classic Veress needle (VN) technique in obese patients.
  
  
  METHODS
  The USE technique was performed on 40 patients. One control per case was randomly selected from among those undergoing the classic VN technique using a random number table. In USE technique, a 12 mm skin incision was created at the superior crease of the umbilical fold, and the underlying subcutaneous adipose tissue was bluntly dissected using the tip of a fine clamp until the umbilical stalk was isolated at the inferior and central part of the incision. Next, the umbilical stalk was covered and held by a towel clip, and the abdominal wall was elevated by upward traction. The VN was then inserted nearly perpendicular to the incision and turned toward the pelvis immediately after resistance to the needle had been lost. A post-hoc power analysis was performed.
  
  
  RESULTS
  The number of attempts was significantly lower in the USE laparoscopy group than in the classic laparoscopy group (1.2 ± 0.4 vs. 2.1 ± 0.7, respectively; P<0.001). The USE technique group had a slightly shorter abdominal entry time than did the classic technique group (328.52 ± 63.71 vs. 434.95 ± 124.10s; P<0.001). Six (7.5%) failed insufflations occurred in our study (5 patients in the classic group vs. 1 patient in the USE group (P=0.10).
  
  
  CONCLUSIONS
  Our novel USE technique can be an effective means of establishing pneumoperitoneum in obese patients undergoing gynecologic laparoscopic procedures.
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey. Electronic address: isaaykutozdemir@hotmail.com.
authors.forename: Aykut
authors.initials: A
authors.lastname: Ozdemir
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Gungorduk
authors.affiliation: Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey.
authors.forename: Kahraman
authors.initials: K
authors.lastname: Ulker
authors.affiliation: Department of Obstetrics and Gynecology, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Yasar
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
authors.forename: Ibrahim Egemen
authors.initials: IE
authors.lastname: Ertas
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gokcu
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
authors.forename: Ulas
authors.initials: U
authors.lastname: Solmaz
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Sanci
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004210:Dissection / Q000379:methods; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications* / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007327:Insufflation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009339:Needles; D009765:Obesity / Q000150:complications*; D061646:Operative Time; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D012189:Retrospective Studies; D050151:Subcutaneous Fat / Q000601:surgery; D014472:Umbilicus / Q000601:surgery*
keywords: Gynecologic laparoscopy; Obese patient; Pneumoperitoneum; Umbilical stalk elevation technique; Veress needle