Real Time Ultrasound Guided Safe Insertion of Veress Needle for Insufflation during Laparoscopy in a Morbidly Obese Woman: A Case Report

Abstract

Induction of pneumoperitoneum during laparoscopy is considered one of the major steps in minimally invasive surgery. Traditionally many surgeons use the blind technique for insertion of Veress needle which has been reported to increase the risk of complications especially in obese patients. In morbidly obese individuals, evidence has shown that this blind entry into the peritoneal cavity for pneumo-insufflation can be difficult. This is because there is an increased risk of subcutaneous layer insufflation causing subcutaneous emphysema in the very obese individuals, and increased risk of visceral and vascular injuries occasioned by overshooting of the Veress needle way too far beyond the desired distance. We present a case report of a very obese patient with previous failed attempt at laparoscopy in which accurate measurement using ultrasound guidance necessitated safe Veress needle entry into the peritoneum and subsequent successful laparoscopy. In conclusion, this case report provides a comprehensive challenges and innovative solutions in performing laparoscopic procedures on morbidly obese patients. It addresses a growing clinical concern with detailed descriptions on the use of ultrasound-guided Veress needle insertion and the management of subcutaneous emphysema, offering practical recommendations that enhance patient safety. By highlighting these advanced methods and emphasizing the importance of patient-specific adaptations, the manuscript contributes valuable insights and practical knowledge that can improve surgical outcomes and inform future research in gynaecological and bariatric surgery in developing countries.