Standardizing The Veress Needle Technique Through The Hasson Lens

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

The core advantage of the Hasson technique lies in its "what you see is what you get" nature, allowing surgeons to mitigate risks by visually confirming the insertion path. To achieve comparable safety levels with the blind Veress needle technique, a rigorously standardized protocol is essential to compensate for the lack of vision. This protocol is, in essence, an extension and translation of the Hasson spirit: "meticulousness, verification, and re-verification."

In the Hasson technique, the process is sequential and deliberate: incision through skin and fascia, blunt dissection of the pre-peritoneal space, and visual entry into the peritoneum. The Veress technique, though blind, follows a logical "layered confirmation" process. Firstly, site selection-typically Palmer's Point or the infraumbilical region-is based on a deep understanding of abdominal wall anatomy to avoid vessels like the inferior epigastric arteries. This mirrors the Hasson technique's precise planning of the incision site.

Secondly, the act of "elevating the abdominal wall"​ is critical. In the Hasson technique, the surgeon uses fingers or retractors to lift the wall, increasing the distance to underlying viscera. Similarly, in the Veress technique, lifting the wall-either manually or with towel clips-serves the identical purpose: creating a safe "pneumoperitoneum space" to prevent inadvertent visceral injury. This physical separation is the bedrock of Veress safety.

The most significant standardization inspired by Hasson is the "Three-Step Test,"​ a clever surrogate for direct visualization. Step one is the "Loss of Resistance" (LOR). The sudden decrease in resistance upon piercing the fascia and peritoneum mimics the tactile sensation a Hasson surgeon feels when contacting the peritoneum. Step two is the Aspiration Test, checking for blood, bowel contents, or urine-equivalent to visually inspecting for bleeding or injury in the Hasson method. Step three is the Hanging Drop Test, observing saline meniscus movement with respiration, exploiting the negative intraperitoneal pressure as an indirect visual cue. Finally, monitoring the initial insufflation pressure (ideally <8 mmHg) confirms intraperitoneal placement.

Every step in this protocol pays homage to the Hasson principle of "verification." The operator is prohibited from relying on a single signal before insufflation. Instead, akin to the Hasson technique, multi-modal validation builds a robust "conviction" regarding needle tip location. This transition from "blind puncture" to "intelligent insertion" is why the Veress technique remains viable and safe in modern surgery. It demonstrates that progress lies not only in instrument refinement but in the relentless standardization and scientification of surgical workflows.