title: Safer trocar insertion for closed laparoscopic access: ex vivo assessment of an improved Veress needle.
abstract: BACKGROUND
  Laparoscopic surgery is widely practiced surgical technique in the modern surgical toolbox. The Veress needle insertion technique, while faster and easier, is associated with higher rates of iatrogenic complications (injury to internal organs, major blood vessels, etc.), morbidity and even mortality with a reported overall risk of 0.32% during surgical interventions. In order to increase the safety and ease of closed insertion technique, we designed and tested an improved prototype of the Veress needle.
  
  
  METHODS
  The new Veress needle includes a distal expandable portion that allows elevation of the abdominal wall and safe insertion of the first trocar over it. The needle was assessed by measurement of ease of insertion, ease of trocar advancement, associated tissue damage, device integrity and weight-bearing capacity on an ex vivo Gallus domesticus animal model: The prototype was tested over 20 times using different traction forces. The experiment was qualitatively repeated on an ex vivo porcine model.
  
  
  RESULTS
  In the G. domesticus model, the improved needle supported forces of up to 5.75 kg F. No damage or mechanical malfunction was seen at any stage of the experiment. Needle penetration, ease of trocar insertion, system anchoring and weight-bearing capacity were rated (1-5) by four raters--mean 4.9 ± 0.31. Inter-rater agreement was high (free marginal κ 0.75). The porcine experiment revealed similar ease of use with neither complication nor damage to the abdominal wall.
  
  
  CONCLUSIONS
  We believe that the new Veress system is easy to use, requires no additional training, non-inferior in its capabilities compared to the traditional Veress needle, with the advantage of improving the safety of the first trocar insertion phase of the operation.
authors.affiliation: Department of General Surgery and Transplantation, Chaim Sheba Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel), Tel-Hashomer, Israel. dr.nevy@gmail.com.|The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel-Hashomer, Israel. dr.nevy@gmail.com.
authors.forename: Avinoam
authors.initials: A
authors.lastname: Nevler
authors.affiliation: Department of General Surgery and Transplantation, Chaim Sheba Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel), Tel-Hashomer, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Har-Zahav
authors.affiliation: Department of General Surgery and Transplantation, Chaim Sheba Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel), Tel-Hashomer, Israel.
authors.forename: Danny
authors.initials: D
authors.lastname: Rosin
authors.affiliation: Department of General Surgery and Transplantation, Chaim Sheba Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel), Tel-Hashomer, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Gutman
mesh_terms: D034861:Abdominal Wall; D000818:Animals; D002645:Chickens; D007049:Iatrogenic Disease / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D008953:Models, Anatomic; D009339:Needles; D012449:Safety; D013525:Surgical Instruments; D013552:Swine; D014143:Traction
keywords: Laparoscopy; Patient safety; Surgical complications; Veress needle