ArticleSurgical endoscopy2026
Stepwise evolution and clinical applicability of negative pressure-based manometric visualization for reliable Veress needle access.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSafe 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.
methodsThis 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.
resultsIn 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.
conclusionReplacing 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.
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