Veres cannula
The Veres cannula or Veres needle is a common gas insufflation cannula for minimally invasive surgery or laparoscopic surgery. It is used to create a pneumoperitoneum using carbon dioxide (CO 2 ) in the abdomen . The abdominal wall is raised by the inflowing gas and allows the surgeon to insert a trocar with only a low risk of injuring internal organs of the abdominal cavity.
history
The Veres needle was developed in 1932 by the Hungarian internist János Veres with the aim of creating a safe puncture method for the establishment of a therapeutic pneumothorax (lung collapse) in the treatment of pulmonary tuberculosis . Veres also used the needle for ascites puncture (removal of abnormal accumulations of fluid in the abdominal cavity). The first description was in Hungarian in 1936. The cannula is rarely used for these purposes today: Pneumothorax treatment of pulmonary tuberculosis is no longer artful, rather flexible plastic or Teflon catheters are used for ascites drainage, which can be safely and specifically inserted under ultrasound control. The name Veress cannula is based on an error in the printing set for publication in the German Medical Weekly in 1938.
construction
The Veres cannula consists of a sharp hollow needle that is inserted over a blunt stylet . When the tissue is pierced, the stylet is pushed back against a spring mechanism so that the needle can separate the tissue. After the penetration, the stylet in the needle slides forward again, preventing injury to the organs and allowing gas to escape in the abdomen. The stylet is connected to the gas supply via a two-way stopcock and a Luer-Lock connector.
application
The Veres cannula is used to create a minimally invasive access for laparoscopic operations. The abdominal wall is pierced and the abdominal cavity is filled with carbon dioxide. Gas pressure and gas flow as well as intra-abdominal pressure are constantly monitored in order to guarantee the position of the access in the free abdominal cavity.
Problems
Despite the protruding stylet, unwanted tissue injuries can occur because the puncture must be performed without visual inspection by the surgeon. Loops of intestine that have grown into the abdominal wall can be punctured unintentionally. This will be clarified by a later endoscopic examination of the surgical area.
As a result of the introduction of carbon dioxide into the abdomen, there is usually a slight hypercapnia . This drop in the pH value in the blood is triggered by absorption of the insufflated carbon dioxide, but can be compensated for by the anesthetist .
See also
literature
- J. Veress: New instrument for performing chest or abdominal punctures and treatment of pneumathorax. From the internal department of the county hospital in Kapuvár (Hungary). German Medical Weekly , October 7, 1938, 64: 1480–1481.
- M. David, AD Ebert: János Veres and the “Veres needle” , obstetric women's health 2008; 68: 374-375, doi : 10.1055 / s-2007-989492
- JR Siewert et al .: Practice of Visceral Surgery , p. 123, Springer-Verlag, Berlin Heidelberg New York, 2002, ISBN 3-540-65950-1
Web links
Notes and individual references
- ↑ Incorrectly also Veress cannula and Veress needle .
- ↑ a b Gynecological Endoscopy Working Group: János Veres (November 14, 1903 - January 27, 1979)
- ↑ Veres, J. Uj Légmellkészit t. Orvosi Hetilap. 1936 (80): 536-7
