Veress Needle Puncture Guided by Ultrasound for Laparoscopy. Study to evaluate Effectiveness and Safety in a Porcine Animal Model.

• Grant number: 23/07441-4
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: August 01, 2023
• End date: July 31, 2024
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Rodrigo Chaves Ribeiro
• Grantee: Jennifer Melissa de Oliveira Marques
• Host Institution: Faculdade de Ciências da Saúde de Barretos Dr Paulo Prata (FACISB). Barretos , SP, Brazil

Abstract

Introduction: Access to the abdominal cavity at laparoscopy can be done blindly with the Veress needle, by directly inserting the trocars, or by the open technique. The form most used by the services is closed with the Veress needle, but this, like the others, has the risk of causing injuries to intra-abdominal structures. In recent years, ultrasonography (USG) has been used in several procedures, such as central venous access and nerve block, in order to reduce possible complications. Objective: Within this context, this work intends to verify the feasibility and feasibility of performing pneumoperitoneum with a Veres needle guided by USG. Materials and Methods: an experimental study in a porcine model. The animal will be anesthetized with general anesthesia with mechanical ventilation. The experiment will consist of an ultrasound-guided abdominal puncture with a Veres needle to create the pneumoperitoneum. High-frequency ultrasound with a linear transducer will be used.Punch with entry in the nipple line at the level of the umbilicus, puncture in plane at 45 degrees. After the puncture, a drop test will be performed and CO2 will be insufflated to 8 mmHG. The sample will be 10 pigs. The animal that will be used will be those used in the IRCAD courses (training center for minimally invasive surgery). The USG will measure the layers of the abdominal wall and the Veress needle will be introduced into the side of the probe. After insufflating the cavity with CO2, the 10 mm trocars will be inserted and the optics will verify the occurrence of complications. The sample will be characterized by: gender, weight, dose of anesthesia. Parameters used from the ultrasound: thickness of the subcutaneous tissue (next to the rectus abdominis), thickness of the lateral muscles, thickness of the peritoneum. Other parameters: measurement of how much the needle penetrated; drop test (positive, equivocal, negative); CO2 insufflation (OK, high-pressure spikes); passage of the trocar (how much was introduced, possible visualization) and optics (injury to the viscera, bleeding). The outcomes analyzed will be the effectiveness of the puncture and whether there were complications.