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

Although the design of the Veress needle has been quite mature, any invasive procedure involves risks. According to literature statistics, the incidence of vascular injuries related to the laparoscopic approach is approximately 0.04% - 0.08%, and intestinal injuries are about 0.03% - 0.14%. Behind these figures, most are directly related to the puncture process of the Veress needle. Understanding these risks and their mechanisms is a mandatory course for every laparoscopic surgeon.

The most common complication is extraperitoneal pneumothorax. When the tip of the Veress needle fails to penetrate the peritoneum completely but remains in the pre-peritoneal space, the injected gas will diffuse into the soft tissues of the abdominal wall, resulting in subcutaneous pneumothorax or mediastinal pneumothorax. The key to prevention lies in the confirmation of the "double breakthrough sensation" during the puncture and the subsequent monitoring of the pneumoperitoneum pressure. If extraperitoneal air is suspected, the inflation should be immediately stopped, the needle removed and re-punctured, or an open method should be used to insert a probe card.

Vascular injury is the most dangerous complication. The abdominal aortic bifurcation is located at the level of the umbilicus, and the iliac vessels run along the lateral wall of the pelvis. If the puncture angle is too biased towards the tail end or laterally, the needle may directly pierce a major blood vessel. The typical warning sign is bright red blood when the syringe is retracted. At this time, it is strictly forbidden to remove the needle - remaining in place can apply pressure to stop the bleeding and provide guidance for subsequent repair. Immediate conversion to laparotomy is necessary, and vascular surgeons should perform suturing. To avoid such disasters, it is recommended to puncture at a 45-degree angle towards the pelvic cavity from the upper edge of the umbilicus, avoiding the aortic bifurcation area.

Although intestinal injury occurs relatively rarely, its consequences can be severe. Patients with a history of abdominal surgery may have the intestinal tract adhered to the abdominal wall, closely following the puncture path. The needle may penetrate the intestinal wall without the patient's awareness, and it may not be discovered until postoperative abdominal inflammation occurs. Preventive measures include: conducting a thorough preoperative assessment of the surgical history, and when necessary, using ultrasound or CT guidance for puncture; for patients with a high suspicion of adhesions, directly choosing the open method to insert the first puncture card. Once during the operation, if the needle brings out intestinal contents or the pneumoperitoneum pressure abnormally increases, one should be vigilant of intestinal perforation and need to thoroughly explore and repair it.

Nerve sheath rupture is a rare mechanical complication. It mostly occurs when using old needles that have been reused or when encountering abnormal resistance during puncture. The broken fragments may remain in the abdominal cavity, causing an inflammatory reaction. The preventive measure is to strictly adhere to the principle of single-use and check the integrity of the needle before each operation. If rupture occurs, the fragments should be immediately located and removed under X-ray fluoroscopy.

Finally, although gas embolism is extremely rare, its fatality rate is extremely high. When the needle accidentally enters the blood vessel and injects a large amount of carbon dioxide, the gas can quickly enter the right heart. This manifests as sudden hypotension, arrhythmia, and cyanosis. The rescue measures include: immediately stopping the gas injection, placing the patient in a head-down left lateral position, and aspirating the gas through the central venous catheter.

In conclusion, although the Veress needle is small in size, it plays a crucial role in ensuring the safety of the entire surgical procedure. Through rigorous preoperative assessment, standardized operating techniques, and prompt emergency handling, the risk of complications can be minimized. Remember: The best way to handle complications is always through prevention.