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Optical Veress as an entry technique

P. McGurgan and P. O’Donovan
M.E.R.I.T. Centre, Bradford Royal Infirmary, Bradford, UK

Keywords ABS TR ACT

laparoscopy, mini/micro, optical, Objective To review the advances in instruments designed for safer entry
review, safety, Veress. into the abdominal cavity.
Design A systematic review of the literature, including a Medline search of
the period from 1966 to February 1999, using the words: laparoscopic, mini,
micro, entry, Veress needle, optical, safety and methods.
Results There are approximately 0.4 Veress needle-related injuries per 1000
procedures. The modified ‘optical’ Veress instruments are designed to
further decrease this rate. Despite extensive studies demonstrating the use
of the latter, there are no large-scale, well-designed trials to confirm their
superiority over the conventional Veress.
Correspondence Conclusion Veress needle-related injuries are rare, but their sequelae can be
P. O’Donovan, M.E.R.I.T. Centre, Bradford
fatal. Many of the alternative instruments have potential advantages over the
Royal Infirmary, Bradford BD9 6RJ, UK.
Veress needle, but lack of quality research means that they are not yet
Accepted for publication 10 June 1999 validated. This must be done by well-planned trials as soon as possible.

We can see that entry-related complications are

relatively infrequent.11–16 Nevertheless, there is no
The Veress started life as an instrument for creating room for complacency; complications rare in the
pneumothoraces in cases of pulmonary tuberculosis, experience of individual surgeons can still represent a
being invented by the respiratory physician, János major problem on an international scale. Of particular
Veress in the 1930s1 The simple design, comprising a concern is the fact that the rates for haemorrhagic and
blunt-tipped, spring-loaded inner stylet and a sharp perforation complications are roughly equal for the
outer needle of up to 16 gauge, was eagerly seized Veress needle and for the trocar.
upon by gynaecologists in the mid-20th century as a What are the alternatives? There is an abundance of
safe instrument for the creation of a pneumoperito- texts and papers describing ‘safe’ techniques for laparo-
neum.2 Many different methods for the creation of scopy,3,16–18 but for the purpose of this article, we have
pneumoperitoneum have since been reported.3 Never- focused on a systematic review of the literature on
theless, the use of the Veress needle followed by blind instruments which are described as improvements on
trocar insertion probably remains the most common the Veress needle.
method, being taught to most practising gynaecologists
during their training.
The technique, however, is associated with a number
of complications,4–10 mainly because the peritoneum We performed a literature search for relevant papers and
might not be entered during the blind insertion, and articles from our own library, along with a Medline
also more seriously, despite the protective spring- search from 1966 to February 1999 using the words:
loaded stylet, the instrument may cause inadvertent laparoscopic, mini, micro, entry, Veress needle, optical,
injury. The frequency of major complications is difficult safety and methods. Papers were reviewed with emphasis
to determine, and various rates are quoted (Table 1). on the quality of their methodology and statistical

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Table 1 Large studies of injuries associated with the Veress needle/trocar4

Study No. of Haemorrhagic Visceral Rate per 1000 cases

laparoscopies complications perforation

Querleu et al.5 17 521 4 Veress/trocar 7 Veress/trocar 0.63

Mintz6 99 204 25 Veress 5 Veress 0.30
18 trocar 26 trocar
Bergqvist & Bergvist7 75 035 4 Veress Not reported 0.07
1 trocar
Jansen8 25 764 5 Veress injuries 0.19
68 trocar

analysis, and the theoretical and practical evidence UK),22–25 which is very similar to the usual disposable
for the superiority of the instrument over the Veress Veress. All the instruments use minilaparoscopes, which
needle. fit into the ‘sleeve’ of an adapted Veress-type needle.
The Optical Veress has a diameter of 2.1 mm and is
10.5 cm long. It is usually inserted by means of the
conventional technique and uses a 1.2-mm diameter
The results of our literature review and liaison with semirigid fibreoptic minilaparoscope (Fig. 1). Similarly,
companies involved in developing alternatives for the the Microlap has a 2-mm diameter and is 14 cm long; it
Veress needle demonstrated the drive to develop instru- uses a 1.98-mm fibreoptic laparoscope, and has an
ments which can replace the conventional device. The anchor engagement device at the distal end to prevent
first optical Veress insruments were developed in the accidental displacement once peritoneal entry is con-
mid-1990s,19 and their introduction has produced firmed (Fig. 2). These instruments remove much of the
reports from many centres (26 Medline citations) uncertainty (and time) associated with the various
advocating their use. indirect tests which are conventionally used to confirm
Modified ‘optical’ Veress instruments attempt to intraperitoneal entry. However, an initially blind tech-
increase the safety of laparoscopic entry by taking nique is still used to gain entry into the cavity, and the
advantage of developments in fibreoptics. The first time required for insufflation can be long if only the
modified Veress was produced by Karl Storz (Tuttlin- Optical Veress is used.
gen, Germany) as the Optical Veress, and there now are As at other centres, we have modified this technique
a variety of instruments on the market. Our experience somewhat by using the Optical Veress at Palmer’s point
has been with the Optical Veress,20–22 a reusable robust in our high risk patients.20,26–28
device, and the Microlap (Nikomed, Hampshire, The small calibre of these instruments, combined
with surprisingly good image quality, has led to the

Figure 1 The Optical Veress (Karl Storz, Tuttlingen,

Germany). Figure 2 The Microlap (Nikomed, Hampshire, UK).

Gynaecological Endoscopy 1999 8, 379–382 q1999 Blackwell Science Ltd


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