https://en.wikipedia.org/wiki/Veress_needle

In the field of modern surgical procedures, laparoscopic technology, with its characteristics of minimally invasive and quick recovery, has completely transformed the traditional open surgical approach. At the beginning of this revolution, there was a seemingly simple yet crucial instrument - the Veress needle. It was not only the first "key" to enter the abdominal cavity but also the cornerstone for establishing pneumoperitoneum. This article will trace the history of the Veress needle and analyze why it has become the unshakable "gold standard" in laparoscopic surgery.

I. Background of Birth: From Tuberculosis Treatment to Laparoscopic Revolution

The Veress needle was invented by Hungarian physician János Veress in 1938. Initially, its design was not intended for laparoscopic surgery, but rather for safer thoracic punctures to drain fluid or gas from the pleural cavity of tuberculosis patients. At that time, the puncture needles were prone to causing damage to the lung tissue. Dr. Veress innovatively introduced a blunt inner core with a spring protection mechanism. Once the needle tip penetrated the tough chest wall, the inner core would immediately pop out, effectively protecting the underlying lung tissue.

This ingenious design concept was recognized by the pioneers of laparoscopic surgery several decades later. In the 1980s, as the laparoscopic cholecystectomy became popular, the key issue was how to safely establish pneumoperitoneum. The traditional open pneumoperitoneum method was very invasive, while directly using sharp puncture devices carried extremely high risks. The Veress needle, with its unique spring protection mechanism, perfectly resolved this contradiction and was quickly introduced into the laparoscopic field and has been used ever since.

II. Structure and Principle: Ingenious "Dual Insurance" Design

As stated in the materials, although the structure of the Veress needle is not complex, its design is extremely ingenious. It is mainly composed of three parts:

1. Outer cannula: A sharp hollow metal tube, usually made of stainless steel, with good hardness and cutting power, facilitating penetration of various layers of abdominal tissues. Its length is typically between 80mm and 150mm, and the outer diameter is between 2.5mm and 5mm, to accommodate the thickness of abdominal walls of patients of different sizes.
2. Inner core (Obturator): A blunt-tipped probe with a spring mechanism. In its natural state, due to the push force of the spring, the blunt inner core extends beyond the tip of the outer cannula.
3. Spring mechanism and valve: This is the core of the Veress needle. When the needle tip presses against the skin, a certain amount of pressure needs to be applied to overcome the spring resistance, causing the inner core to retract and exposing the sharp tip of the outer cannula for puncture. Once the abdominal wall is penetrated and enters the abdominal cavity, the resistance disappears, and the spring instantly pushes the blunt inner core out, allowing it to once again cover the sharp tip of the outer cannula. Additionally, the needle tail is equipped with a one-way valve for connecting the pneumoperitoneum machine to inject carbon dioxide gas.

III. Reasons for Becoming the "Gold Standard"

The Veress needle has remained in use for decades and is widely employed globally, mainly due to the following reasons:

• High safety: The spring protection mechanism is the most remarkable feature. During the puncture process, it can minimize the accidental damage to vital organs such as the intestines and major blood vessels within the abdominal cavity. Even if the intestinal tract is accidentally touched, the blunt inner core can provide buffering and protection, reducing the puncture injury to the minimum.
• Minimal trauma: Compared to the open Hasson method that requires cutting through the anterior and posterior sheaths of the rectus abdominis muscle, the Veress needle only requires a tiny incision of approximately 2-5 millimeters to complete the puncture. It causes minimal damage to the abdominal wall muscles and fascia, resulting in less postoperative pain and faster healing.
• High efficiency: The operation process is standardized, and the learning curve is relatively short. Skilled surgeons can complete the puncture and start inflation within tens of seconds, significantly reducing the preoperative preparation time.
• Low cost: The Veress needle is usually made of reusable stainless steel material. Although there are also disposable products, its overall cost is much lower than other complex puncture devices.

IV. Summary and Outlook

From the thoracic puncture needle used in treating tuberculosis to the "pioneer" of laparoscopic surgeries, the evolution of the Veress needle has witnessed the development of minimally invasive surgery. Although in recent years, new devices such as optical puncture devices and visual puncture devices have emerged, attempting to provide more direct visual guidance, the Veress needle still remains the preferred method for the majority of laparoscopic surgeries due to its simple, reliable, low-cost, and high-safety comprehensive advantages. It is not merely a tool, but rather a surgical philosophy that has stood the test of time - achieving the greatest safety with the least cost. For every surgeon aspiring to perform laparoscopic surgeries, understanding and mastering the use of the Veress needle is the first and most important step in opening the door to minimally invasive surgery.