Surgery

Trocar (5) by VERESS

The VERESS needle (also known as the VERRES needle) is a special kind of trocar: every laparoscopy begins with the insertion of the VErRES needle.

The first laparoscopy in humans was performed in 1910 by the Swede Hans Christian JACOBAEUS in Stockholm. In 1933 VEWERS first filled carbon dioxide into the abdominal cavity instead of air. This has the advantage that residual gas in the stomach are painlessly absorbed by the body and that you can easily work with electrical instruments.

The assistant of the Surgical University Hospital Halle Otto GÖTZ (X-ray diagnostics in gas-filled abdominal cavity, a new method) developed in 1918 an automatic special needle for the safe introduction of gas into the abdominal cavity - purpose of his method was the production of double contrast X-ray photographs.

A significant advancement of endoscopic technique was achieved in 1938, when the Hungarian surgeon Janos VERESS "rediscovered" the needle of GÖTZE and used it for a safe puncture of ascites and a safe system of pneumothorax (treatment of pulmonary tuberculosis) - he applied this needle to the 2,000 times, but NEVER used them to create a pneumoperitoneum. NEVER he suggested using them to create a pneumoperitoneum! Nevertheless, apart from minor modifications, the needle is nowadays used for the installation of such pneumoperitones!

The VERESS needle has a centrally-rounded pin rounded off at the tip, which is pushed forward by a spring as soon as the peritoneum is pierced, thus avoiding injury to internal organs. The gas is introduced via a lateral opening on the advanced central pin. Once the tip of the needle has punctured the peritoneum, the blunt stylet snaps in and prevents bowel injury. Gas is then pumped into the abdominal cavity through the laterally perforated stylet (pneumoperitonaeum): the brook covers are lifted off the intestinal loops; The surgeon can push the laparoscope into the space created in this way.

One-third to one-half of complications in laparoscopy occur during insertion of the needle or the first trocar (Leonard 2000, Chapron 1998). A vascular injury caused by a Verresnadel or the first trocar is a typical, overall rare, but well-known complication of a laparoscopy, which can not be avoided even with all due care, because these instruments must be introduced without visual inspection. The injury of a vessel therefore does not indicate a faulty procedure of the physician.

As a site for the insertion of the VERRES needle, a wide variety of sites were recommended

- left subcostal

- the posterior vaginal vault

- the uterine fundus by guiding the needle vaginally through the cervical canal (in particular, this puncture is suitable for obese women)

- The lower circumference of the navel - the common puncture site. As a place of puncture, the umbilical pit is usually taken, because here the distance between the skin and the abdominal cavity is thinnest. In addition, the wound in the navel and re-stitched wound visually not later ...

Note: the Verres needle may also be advanced into the pleural space at the top of the third rib for thoracoscopy.