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Background <p>Safe establishment of pneumoperitoneum is essential in laparoscopic surgery because most access-related injuries occur during peritoneal entry. In Veress needle procedures, this step is performed blindly, and conventional verification tests are subjective and often unreliable. The negative pressure-based visualization (NPV) technique enables real-time confirmation of peritoneal entry using a saline column. We therefore developed a manometric modification (NPMV) and a four-forceps technique (NPMV4) to improve practicality and applicability in obese patients.</p> Methods <p>This retrospective study included two cohorts: a standard-weight cohort of 475 patients undergoing laparoscopic groin hernia repair (243 NPMV, 232 NPV) and an obese cohort of 53 patients undergoing laparoscopic sleeve gastrectomy (33 four-forceps, 20 two-forceps). In the NPMV, the Veress needle was connected to an insufflator with a manometric display, and peritoneal entry was confirmed at a pressure of minus 2&#xa0;mmHg or lower. Primary outcomes were pneumoperitoneum success and access-related complications; secondary outcomes included access time and puncture attempts.</p> Results <p>In the standard-weight cohort, pneumoperitoneum success was 99% in both groups, with no differences in complications or puncture attempts. The NPMV group achieved a significantly shorter time to insufflation (median 1.0 vs 2.0&#xa0;min, <i>p</i> &lt; 0.001). In the obese cohort, the four-forceps group showed fewer failed entries (3% vs 15%) and significantly fewer puncture attempts (median 1.0 vs 3.5, <i>p</i> = 0.019), without increased gas-related complications.</p> Conclusion <p>Replacing the saline column with a manometric display did not increase access-related complications and improved procedural efficiency. The NPMV4 technique further&#xa0;improved the reliability of laparoscopic access in obese patients. These stepwise modifications provide a simple, reproducible, and reliable approach to Veress needle access across diverse surgical populations.</p>

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Stepwise evolution and clinical applicability of negative pressure-based manometric visualization for reliable Veress needle access

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Masanori Sato,
  • Kakeru Torii,
  • Yoshihiro Hiramatsu,
  • Yuki Sakai,
  • Ryoma Haneda,
  • Wataru Soneda,
  • Tomohiro Murakami,
  • Eisuke Booka,
  • Tomohiro Matsumoto,
  • Hirotoshi Kikuchi,
  • Hiroya Takeuchi

摘要

Background

Safe establishment of pneumoperitoneum is essential in laparoscopic surgery because most access-related injuries occur during peritoneal entry. In Veress needle procedures, this step is performed blindly, and conventional verification tests are subjective and often unreliable. The negative pressure-based visualization (NPV) technique enables real-time confirmation of peritoneal entry using a saline column. We therefore developed a manometric modification (NPMV) and a four-forceps technique (NPMV4) to improve practicality and applicability in obese patients.

Methods

This retrospective study included two cohorts: a standard-weight cohort of 475 patients undergoing laparoscopic groin hernia repair (243 NPMV, 232 NPV) and an obese cohort of 53 patients undergoing laparoscopic sleeve gastrectomy (33 four-forceps, 20 two-forceps). In the NPMV, the Veress needle was connected to an insufflator with a manometric display, and peritoneal entry was confirmed at a pressure of minus 2 mmHg or lower. Primary outcomes were pneumoperitoneum success and access-related complications; secondary outcomes included access time and puncture attempts.

Results

In the standard-weight cohort, pneumoperitoneum success was 99% in both groups, with no differences in complications or puncture attempts. The NPMV group achieved a significantly shorter time to insufflation (median 1.0 vs 2.0 min, p < 0.001). In the obese cohort, the four-forceps group showed fewer failed entries (3% vs 15%) and significantly fewer puncture attempts (median 1.0 vs 3.5, p = 0.019), without increased gas-related complications.

Conclusion

Replacing the saline column with a manometric display did not increase access-related complications and improved procedural efficiency. The NPMV4 technique further improved the reliability of laparoscopic access in obese patients. These stepwise modifications provide a simple, reproducible, and reliable approach to Veress needle access across diverse surgical populations.