Using Veress Needle for Laparoscopy in Females with Prior Cesarean Section: Considerations and Safety Implications

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Humberto Lugo Vicente Derick Rodriguez Reyes Juan C. Bonilla


Laparoscopic surgery has brought about a significant transformation in modern surgical practices, offering numerous advantages such as reduced postoperative discomfort and quicker recovery times. However, the initial step of accessing the abdominal cavity presents inherent challenges, especially in patients with previous cesarean sections, whose abdominal anatomy may be altered by adhesions or scar tissue. Among the techniques used to establish pneumoperitoneum, the Veress needle method is commonly employed, yet its safety in females with prior cesarean sections requires careful consideration. This paper provides a thorough examination of safety outcomes, strategies for managing complications, and the long-term implications of Veress needle insertion in females with prior cesarean sections undergoing laparoscopic surgery. It delves into the evolution of laparoscopic surgery, emphasizing the need for a nuanced understanding of the challenges posed by altered abdominal anatomy. Drawing from diverse literature, including peer-reviewed articles and clinical studies, the paper explores the intricacies of preoperative assessment, highlighting the importance of comprehensive patient evaluation to identify potential risk factors and inform surgical planning. Furthermore, it investigates refinements in surgical techniques, examining novel approaches and safety measures proposed to mitigate the risks associated with Veress needle insertion in this specific patient population. From innovative methods for measuring the depth of the anterior abdominal wall to alternative entry sites and techniques, such as the open (Hasson) technique or left upper quadrant (Palmer's point) entry, the paper elucidates the multifaceted strategiesemployed to enhance safety and efficacy. Additionally, it addresses acute safety concerns and long-term complications, advocating for ongoing monitoring and follow- up care. Identifying research gaps, the paper calls for further investigation to refine safety protocols and improve patient outcomes, ultimately aiming to enhance patient well-being in this specific patient cohort.

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VICENTE, Humberto Lugo; REYES, Derick Rodriguez; BONILLA, Juan C.. Using Veress Needle for Laparoscopy in Females with Prior Cesarean Section: Considerations and Safety Implications. Medical Research Archives, [S.l.], v. 12, n. 5, may 2024. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
Research Articles


1. Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13(1):1-5.
2. Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol. 2015;5(4):238-254. Published 2015 Dec 26. Doi:10.5662/wjm.v5.i4.238
3. Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS. 2001;5(1):89-94.
4. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. Published 2009 Jul 21. Doi:10.1136/bmj.b2700
5. Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg. 2012;16(10):1929-1939. Doi:10.1007/s11605-012-1972-9
6. Thomson JE, Kruger D, Jann-Kruger C, et al. Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surg Endosc. 2015;29(7):2027-2032. Doi:10.1007/s00464-014-3906-y
7. Markides G, Subar D, Riyad K. Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg. 2010;34(9):2026-2040. Doi:10.1007/s00268-010-0669-z
8. Li X, Zhang J, Sang L, et al. Laparoscopic versus conventional appendectomy--a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129. Published 2010 Nov 3. Doi:10.1186/1471-230X-10-129
9. Wei B, Qi CL, Chen TF, et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011;25(4):1199-1208. Doi:10.1007/s00464-010-1344-z
10. Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg. 1998;186(5):545-553. Doi:10.1016/s1072-7515(98)00080-5
11. Markar SR, Penna M, Harris A. Laparoscopic approach to appendectomy reduces the incidence of short- and long-term post-operative bowel obstruction: systematic review and pooled analysis. J Gastrointest Surg. 2014;18(9):1683-1692. Doi:10.1007/s11605-014-2572-7
12. Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009;201(1):56.e1-56.e566. Doi:10.1016/j.ajog.2009.04.039
13. Soltan MH, Al Nuaim L, Khashoggi T, Chowdhury N, Kangave D, Adelusi B. Sequelae of repeat cesarean sections. Int J Gynaecol Obstet. 1996;52(2):127-132. Doi:10.1016/0020-7292(95)02561-8
14. Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. Multiple cesarean section morbidity. Int J Gynaecol Obstet. 2004;87(3):227-232. Doi:10.1016/j.ijgo.2004.08.016
15. Morales KJ, Gordon MC, Bates GW Jr. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol. 2007;196(5):461.e1-461.e4616. Doi:10.1016/j.ajog.2006.12.017
16. Uygur D, Gun O, Kelekci S, Ozturk A, Ugur M, Mungan T. Multiple repeat caesarean section: is it safe?. Eur J Obstet Gynecol Reprod Biol. 2005;119(2):171-175. Doi:10.1016/j.ejogrb.2004.07.022
17. Hesselman S, Högberg U, Råssjö EB, Schytt E, Löfgren M, Jonsson M. Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study. BJOG. 2018;125(5):597-603. Doi:10.1111/1471-0528.14708
18. Alam F, Badminton R, Tsvetkov F, Hanif Z, Payne R. Safe insertion of Veress needle for the induction of pneumoperitoneum: a technical note. J Surg Case Rep. 2023 Jun 1;2023(6):rjad311. Doi: 10.1093/jscr/rjad311. PMID: 37274630; PMCID: PMC10234602.
19. Vilos GA, Ternamian A, Dempster J, Laberge PY. No. 193-Laparoscopic Entry: A Review of Techniques, Technologies, and Complications. J Obstet Gynaecol Can. 2017;39(7):e69-e84. Doi:10.1016/j.jogc.2017.04.013
20. Güven E, Dura MC, Aktürk H, Güraslan H. Safety of Laparoscopic Entry Points in Patients With a History of Abdominal Surgery: A Research Article. Cureus. 2023;15(10):e47244. Published 2023 Oct 18. Doi:10.7759/cureus.47244
21. Krishnakumar S, Tambe P. Entry complications in laparoscopic surgery. J Gynecol Endosc Surg. 2009;1(1):4-11. Doi:10.4103/0974-1216.51902
22. Marchand GJ, Masoud A, King A, Brazil G, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Moir C, Christensen A, Alexander T, Govindan M. Systematic review and meta-analysis of Veress needle entry versus direct trocar entry in gynecologic surgery. BMJ Surgery, Interventions, & Health Technologies. 2022;4:e000121..
23. Levy L, Tsaltas J. Recent advances in benign gynecological laparoscopic surgery. Fac Rev. 2021;10:60. Published 2021 Jul 26. Doi:10.12703/r/10-60
24. Miti C, Busuulwa P, Scott R, Bloomfield-Gadelha H. Primary entry trocar design and entry-related complications at laparoscopy in obese patients: meta-analysis. BJS Open. 2023;7(3):zrad047. Doi:10.1093/bjsopen/zrad047
25. Jain N, Sareen S, Kanawa S, Jain V, Gupta S, Mann S. Jain point: A new safe portal for laparoscopic entry in previous surgery cases. J Hum Reprod Sci. 2016;9(1):9-17. Doi:10.4103/0974-1208.178637
26. Tulikangas PK, Robinson DS, Falcone T. Left upper quadrant cannula insertion. Fertil Steril. 2003;79(2):411-412. Doi:10.1016/s0015-0282(02)04668-x
27. Chang FH, Chou HH, Lee CL, Cheng PJ, Wang CW, Soong YK. Extraumbilical insertion of the operative laparoscope in patients with extensive intraabdominal adhesions. J Am Assoc Gynecol Laparosc. 1995;2(3):335-337. Doi:10.1016/s1074-3804(05)80119-7
28. Kumakiri J, Takeuchi H, Sato Y, et al. A novel method of ninth-intercostal microlaparoscopic approach for patients with previous laparotomy. Acta Obstet Gynecol Scand. 2006;85(8):977-981. Doi:10.1080/00016340600607065
29. van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007;9 Suppl 2:25-34. Doi:10.1111/j.1463-1318.2007.01358.x
30. Fei Y, Wen J, Li X, Wang N, Chen M, Jiang X. Uterine adhesion: Is luteal phase prior to follicular phase in uterine adhesiolysis?. Medicine (Baltimore). 2021;100(37):e27194. Doi:10.1097/MD.0000000000027194
31. Rajab TK, Ahmad UN, Kelly E. Implications of late complications from adhesions for preoperative informed consent. J R Soc Med. 2010;103(8):317-321. Doi:10.1258/jrsm.2010.090378
32. Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001;7(6):567-576. Doi:10.1093/humupd/7.6.567
33. Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril. 1982;37(5):593-610. Doi:10.1016/s0015-0282(16)46268-0
34. Azevedo JL, Azevedo OC, Miyahira SA, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009;23(7):1428-1432. Doi:10.1007/s00464-009-0383-9
35. Madhok B, Nanayakkara K, Mahawar K. Safety considerations in laparoscopic surgery: A narrative review. World J Gastrointest Endosc. 2022;14(1):1-16. Doi:10.4253/wjge.v14.i1.1
36. Scaletta G, Dinoi G, Capozzi V, et al. Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review. Eur J Surg Oncol. 2020;46(5):782-788. Doi:10.1016/j.ejso.2019.11.519
37. Hewett PJ, Allardyce RA, Bagshaw PF, et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg. 2008;248(5):728-738. Doi:10.1097/SLA.0b013e31818b7595
38. Litynski GS. Kurt Semm and the fight against skepticism: endoscopic hemostasis, laparoscopic appendectomy, and Semm's impact on the "laparoscopic revolution". JSLS. 1998;2(3):309-313.
39. Antoniou SA, Antoniou GA, Antoniou AI, Granderath FA. Past, Present, and Future of Minimally Invasive Abdominal Surgery. JSLS. 2015;19(3):e2015.00052. Doi:10.4293/JSLS.2015.00052
40. Olsen DO. Bile duct injuries during laparoscopic cholecystectomy: a decade of experience. J Hepatobiliary Pancreat Surg. 2000;7(1):35-39. Doi:10.1007/s005340050151
41. Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998;32(5):1389-1396. Doi:10.1016/s0735-1097(98)00406-9
42. Omar I, Graham Y, Singhal R, Wilson M, Madhok B, Mahawar KK. Identification of Common Themes from Never Events Data Published by NHS England. World J Surg. 2021;45(3):697-704. Doi:10.1007/s00268-020-05867-7
43. Vilos GA, Ternamian A, Laberge PY, et al. Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery [published correction appears in J Obstet Gynaecol Can. 2021 Sep;43(9):1120-1121]. J Obstet Gynaecol Can. 2021;43(3):376-389.e1. Doi:10.1016/j.jogc.2020.12.012
44. Alhajress GI, Al Babtain I, Alsaghyir A, Arishi H. Complications of Veress Needle Versus Open Technique in Abdominal Surgeries. Cureus. 2021;13(5):e14926. Published 2021 May 9. Doi:10.7759/cureus.14926
45. Shaikh N, E-Amara U, Sajeer A, et al. Laparoscopic Major Vascular Injuries Report of Two Cases and Review. Int Med Case Rep J. 2023;16:7-11. Published 2023 Jan 5. Doi:10.2147/IMCRJ.S394281
46. Valente M, Campanelli M, Benavoli D, et al. Safety and Outcomes of Laparoscopic Sleeve Gastrectomy in a General Surgery Residency Program. JSLS. 2021;25(1):e2020.00063. Doi:10.4293/JSLS.2020.00063
47. Xue FS, Liu GP, Li RP. Association of emergency general surgery with excess postoperative morbidity and mortality. J Trauma Acute Care Surg. 2015;78(6):1234-1235. Doi:10.1097/TA.0000000000000637
48. Tjeertes EK, Ultee KH, Stolker RJ, et al. Perioperative Complications are Associated With Adverse Long-Term Prognosis and Affect the Cause of Death After General Surgery. World J Surg. 2016;40(11):2581-2590. Doi:10.1007/s00268-016-3600-4
49. Fantola G, Brunaud L, Nguyen-Thi PL, Germain A, Ayav A, Bresler L. Risk factors for postoperative complications in robotic general surgery. Updates Surg. 2017;69(1):45-54. Doi:10.1007/s13304-016-0398-4
50. Javed H, Olanrewaju OA, Ansah Owusu F, et al. Challenges and Solutions in Postoperative Complications: A Narrative Review in General Surgery. Cureus. 2023;15(12):e50942. Published 2023 Dec 22. Doi:10.7759/cureus.50942
51. Bensley RP, Schermerhorn ML, Hurks R, et al. Risk of late-onset adhesions and incisional hernia repairs after surgery. J Am Coll Surg. 2013;216(6):1159-116812. Doi:10.1016/j.jamcollsurg.2013.01.060
52. Muller S, Langø T, Brekken R, Ystgaard B. Degree of adhesions after repair of incisional hernia. JSLS. 2010;14(3):399-404. Doi:10.4293/108680810X12924466006486