Inserting a needle into the abdomen and peritoneal cavity for the purpose of instilling carbon dioxide gas in preparation for laparoscopy is essentially very safe because of the design of the Verres needle: once the resistance of the abdominal wall is overcome a sheath slides over the sharp needle to prevent it damaging bowel and other organs. The devices used to instil gas have pressure controls which limit the flow of gas under conditions of high pressure. Normally the Verres needle is inserted at the umbilicus but where there are greater risks of bowel lying close by (such as with previous abdominal surgery) a higher insertion point may be advisable (Palmer’s point :3cm below the left rib margin).Alternatively an open Hasson approach to gas insufflation can be used with an incision at the umbilicus but this is not completely free of such complications .The chance of adhesions being present near the umbilicus is high (~50%) where a previous vertical incision has been made in the abdomen.
The risk of bowel damage in large series of laparoscopy is between 1-2 per thousand cases. This is commonly a small bowel injury and is often caused by the Verres needle. However electocautery is also a cause of bowel perforation particularly where electric current sparks across the peritoneal cavity causing bowel burns (“capacitance coupling”).
Other vital structures such as major blood vessels are occasionally damaged by the Verres needle (~2 per ten thousand cases ) and these may require open surgery to repair them.
|Tags: Laparoscopic Injuries|