Abdominal access following insufflation with Veress needle at high pressure: A security maneuver for the reduction of surgical complications during laparoscopic access

Abstract

Introduction

Up to 50% of laparoscopic complications arise during access maneuvers to abdominal cavity. Our aim is to determine whether elevated pressures of 20–25 mmHg during these maneuvers, by increasing the distance between the abdominal wall and intracavitary organs, can help reduce the risk of entry-related complications, without an increase in anesthetic adverse effects.

Methods and materials

Prospective observational analytic multi-centered cohort study with 703 patients. The exposed-cohort consisted of patients undergoing gynecological laparoscopic surgeries in which an intra-abdominal pressure of 20–25 mmHg was used (group 20–25 mmHg) as opposed to the unexposed-cohort, in which usual < 15 mmHg pressures (group < 15 mmHg) were used. All surgeries were performed using the Veress needle as the method of insufflation.

Results

Patients in whom access was performed at pressures < 15 mmHg had a higher risk of complications than those in whom elevated pressures of 20–25 mmHg were used, which was statistically significant (OR 3.08, 95% CI95% 1.42–6.65, p = 0.004), without finding differences regarding anesthetic complications (p = 0.9).

Conclusion

The use of high intraabdominal pressure during access maneuvers serves as an effective technique for the prevention of complications, especially major complications, when compared with standard-used pressures, without increasing the incidence of anesthetic adverse effects, due to their temporary maintenance.