Veress needle with optical protective shield and step system: A new safety concept in minimally invasive surgery

Summary

The insertion of trocars under visual guidance has been developed to a safe procedure. However, ‘blind’ primary puncture for insufflation with a Veress needle still carries a well-recognised risk of injuries. We have added specific optical features to the protective shield of a conventional Veress needle with the aim of minimising these risks. The resulting special Veress needle, with an optical protective shield, allows us to benefit from the advantages of optical trocars (Optiview trocars; Ethicon Endosurgery, Cincinnati, USA) during the primary puncture. Orientation within the tissue layers and visualisation of adhesions and intraperitoneal organs is therefore possible prior to the penetration of the peritoneum. This Veress needle consists of a conventional needle with an integrated spring mechanism. The spring-activated protective shield allows the integration of a fibre glass optic at the distal end of the protective shield. The tissue surrounding the transparent shield is thus visible. The protective shield and optic are not mechanically tied to each other. We have modified this needle to suit the non-trocar Dilatation System Step (Innerdyne, California, USA). This gives a system capable of performing primary punctures under the usual Veress needle conditions, but the area to be accessed can be viewed. At the same time, a sleeve (an expandable trocar bushing) is brought into the intra-abdominal area and dilated to an internal diameter of 7, 10 or 12 mm. After dilatation, high-flow insufflation takes place under optical monitoring, e.g. with a 10 mm optic. Diagnostic inspection is therefore possible while insufflation is still in progress; this is considerably less time-consuming than the conventional method. The area to be diagnosed can be accessed repeatedly using the same Veress needle and various sleeves. Such an approach makes it unnecessary to use classical trocar systems. A more effective utilisation of instrumentation is also more cost-effective. The dilatable sleeves are always brought in with the low penetration pressure of the Veress needle and under visual control. Dilatation trocars are used to spread the sleeves, thus risks can be reduced to a minimum.

Key Words:

• optical Veress needle
• non-trocar Dilatation System