Insuflación con aguja de Veress en punto de Palmer, hasta presión intraabdominal de 25 mmHg. Técnica para mejorar la seguridad del acceso laparoscópico ginecológico

Abstract

Objectives: The aim of the study is to observe the benefits of laparoscopic trocar entry for optics, after previous insufflation with Veress needle at Palmer´s point, until an intra-abdominal pressure of 25 mmHg is achieved. Material and method: Prospective study of 115 laparoscopic surgeries performed with the previously described technique, by the same surgical team; from July 2014 to March 2018, in the Department of Gynecology of the Hospital General Santa María del Puerto. Results: The average time of access maneuvers was 175 seconds. In 84.3% of the cases, access to the abdominal cavity was achieved on the first attempt. Only on two occasions (1.7%), it was necessary to change the access technique. No complication or adverse effect was found in 96.5% of the surgeries. Subcutaneous emphysema (1.7%) occurred in two patients, epiploic emphysema (0.9%) and in one patient (0.9%), a slight anesthetic intolerance was observed during the pneumoperitoneum. No major complications associated with the access maneuvers were recorded during the study. Conclusions: The entry with high intra-abdominal pressures after insufflation with Veress needle at Palmer´s point, is a safe and reproducible technique to avoid major complications, during maneuvers of access to the abdominal cavity. In addition, this technique does not produce relevant adverse anesthetic effects secondary to high pressures in healthy patients, due to the short time during which they remain.