Veress needle entry (RANZCOG) Flashcards
What percentage of injuries occur at laparoscopic entry?
50%
Most common life threatening injuries occurring during laparoscopy?
vascular or bowel injury
Overall complication rate associated with gynaecological laparoscopy?
3-8/1000
Veress entry: Recommended equipment available:
- scalpel, size 11 or 15 blade
- Veress needle. test sharpness and spring.
- insufflator and tubing. check free flow through needle.
- light lead, camera and laparoscope
- appropriate number and size of tracers for procedure
recommended incision for verses needle?
intra-umbilical skin incision from centre–> caudally
Steps for Veress insertion?
- ensure tap open
- +/- splint abdominal wall with non-dominant hand
- hold veress a few cm above the needle tip to control insertion
- continuous pressure at umbilical base
- single or dual loss of resistance felt for
- hold veress still
- test: aspiration and saline drop tests.
- pressure test. 5 successive pressures of <8mmHg = correct placement.
After how many Veress placement attempts should placement be reconsidered?
3
At what flow should insufflation via veress commence?
1-3L/min.
At what pressure should primary trocar entry be attempted?
20-25mmHg.
What should the pressure be set to for diagnostic/operative component of the procedure?
15mmHg
What alternate sites can Veress be inserted?
Palmer’s point
RUQ
Suprapubically
Transfundally through the uterus
Gynae categorisation: What is the usual urgency category of curettage and evacuation of uterus?
Category 1
What urgency category is BSO, oophorectomy or ovarian cystectomy?
category 2
Define category 1 for gynaecological elective urgency?
Indicated within 30 days
Define elective clinical urgency category 2?
Within 90 days
