A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall

A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall

Postema, R.R. (TU Delft Medical Instruments & Bio-Inspired Technology; VU University Medical Centre)
Cefai, David (ProVinci Medtech)
van Straten, Bart (TU Delft Medical Instruments & Bio-Inspired Technology)
Miedema, R.S.J. (TU Delft Biomechatronics & Human-Machine Control)
Lesmana Hardjo, L. (Student TU Delft)
Dankelman, J. (TU Delft Medical Instruments & Bio-Inspired Technology)
Nickel, Felix (Heidelberg University Hospital)
Horeman, T. (TU Delft Medical Instruments & Bio-Inspired Technology)

2021

Background: Complications that occur in laparoscopic surgery are often associated with the initial entry into the peritoneal cavity. The literature reported incidences of Veress needle (VN) injuries of e.g. 0.31% and 0.23%. In a 2010 national survey of laparoscopic entry techniques in the Canadian General Surgical practice, 57.3% of respondents had either experienced or witnessed a serious laparoscopic entry complication like bowel perforation and vascular injury. As those complications are potentially life threatening and should be avoided at all costs, improving safety of this initial action is paramount. Methods: Based on a bare minimum design approach with focus on function expansion of existing components, a new Safety mechanism was developed for the VN that decreases the risks of VN overshooting. The mechanism works by preventing the puncturing acceleration of the tip of the VN by decoupling the surgeon’s hand from the VN immediately after entering the abdomen. Results: Based on a set of requirements, a first prototype of the VN+ with force decoupling safety mechanism is presented and evaluated on an ex vivo porcine abdominal wall tissue model in a custom setup. The experiments conducted by two novices and one experienced surgeon indicated a significant difference between the attempts with a standard, conventional working VN (41.4 mm [37.5–45 mm]) and VN+ with decoupling mechanism (20.8 mm [17.5–22.5 mm]) of p < 0.001. Conclusion: A new decoupling safety mechanism was integrated successfully in a standard VN resulting in a VN+. The results from the pilot study indicate that this new VN+ reduces overshooting with a minimum of 50% in a standardised ex vivo setting on fresh porcine abdominal wall specimens.

Laparoscopy
Veress needle
Safety Mechanism

http://resolver.tudelft.nl/uuid:cc467e98-cc4c-42ac-91bc-2cae7cc8a1d0

https://doi.org/10.1007/s00464-021-08603-x

1432-2218

Surgical Endoscopy: surgical and interventional techniques (online), 35 (10), 5857-5866

Institutional Repository

journal article

© 2021 R.R. Postema, David Cefai, Bart van Straten, R.S.J. Miedema, L. Lesmana Hardjo, J. Dankelman, Felix Nickel, T. Horeman