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

Although the Veress needle has been the main force for establishing pneumoperitoneum in laparoscopic surgeries for over four decades, medical technology has never stood still. With the rapid development of visualization technology, artificial intelligence, and materials science, the Veress needle itself is constantly evolving, and at the same time, some new alternative technologies have begun to emerge. This article will look forward to the future development direction of the Veress needle and explore how emerging technologies will reshape the entry method of laparoscopic surgeries.

I. The Innovative Evolution of the Veress Needle Itself

The traditional Veress needle is a purely mechanical device, and its biggest drawback is "blind insertion." The future Veress needle is evolving in two directions: "visualization" and "intelligence."

1. Visualized Veress Needle:

• Optical Veress Needle: This is the most mature improved type. It integrates a miniature fiber optic lens and light source within the hollow needle core. Doctors can observe the tissue layers along the puncture path through the eyepiece or display screen: yellow subcutaneous fat, white fascia, red muscle, and transparent peritoneum. When the lens detects the intestines or peritoneum in the abdominal cavity, it confirms the puncture success. This significantly reduces the risk of blind puncture, especially for obese and adherent patients.
• Ultrasound-guided Veress Needle: A miniature ultrasound probe is integrated at the needle tip. It not only provides two-dimensional images but also detects blood vessels in front of the needle tip through the Doppler effect, enabling "seeing the blood flow and detouring around." This is expected to fundamentally eliminate damage to major blood vessels.

2. Intelligent Veress Needle:

• Pressure Sensing Veress Needle: A miniature pressure sensor is integrated at the needle tip to measure the tissue resistance during the puncture process. When encountering different tissues, the resistance waveform will show characteristic changes. For example, the resistance will suddenly increase when passing through the fascia, and it will drop to zero suddenly after passing through the peritoneum. The instrument can automatically identify these waveforms and alert the doctor through sound or light, and even automatically lock the puncture action when an abnormality is detected (such as contacting a pulsating major blood vessel).

II. The Rise of Alternative Technologies: Who Will Replace the Veress Needle?

Apart from improving the Veress needle, some revolutionary new technologies are challenging its "gold standard" status.

1. Optical Trocar:

• Principle: This is an integrated puncture device, with a blunt-tipped optical cannula at its center, encased in a transparent plastic shell. During the puncture, the doctor views the front end of the cannula through the laparoscopic lens, observing the process of the abdominal wall layers being gently pushed apart rather than being cut. The entire process is visible throughout.
• Advantages: Theoretically, it is safer than the Veress needle as it achieves "what you see is what you get," avoiding blind punctures. It is particularly suitable for patients with a history of abdominal surgery.
• Disadvantages: It is expensive and mostly used once; it requires a larger puncture site (usually 5mm or 10mm); it has a certain learning curve for the operator.

2. Open Hasson Method:

• Principle: This is a classic non-puncture method. A 1-2cm incision is made directly at the navel, and the skin, subcutaneous tissue, fascia, and peritoneum are sequentially cut layer by layer. The abdomen is then entered under direct vision, and a blunt-tipped cannula is placed before suturing and fixing.
• Advantages: It is absolutely safe and has no risk of blind puncture. It is the "gold standard" for handling high-risk patients (such as extensive adhesions, pregnancy).
• Disadvantages: The trauma is slightly greater, and the procedure takes longer. Postoperatively, there may be incision hernia or leakage.

3. Single-port Laparoscopy (LESS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES):

• Principle: LESS involves inserting multiple instruments through a small incision (about 2-3cm) at the navel; NOTES involves entering the abdomen through the mouth, vagina, or rectum. Both of these techniques fundamentally change the way of establishing pneumoperitoneum and may require specially designed puncture devices.
• Impact: They may gradually weaken the position of the Veress needle in traditional multi-port laparoscopy, but they are still niche technologies at present.

III. Future Outlook: Coexistence and Integration

For a long time to come, the Veress needle is unlikely to be completely replaced. Its low cost, simple structure, and mature application experience are what give it its strong vitality. However, its shape and usage method will change.

• Layered usage: For patients with low-risk initial surgeries, the classic Veress needle remains the best choice. For high-risk patients, visual Veress needles or optical puncture devices will become the mainstream. In extreme cases, the Hasson method serves as the ultimate safeguard.
• Technological integration: In the future, Veress needles may evolve into an "intelligent sensor platform," integrating optical, pressure, and electrophysiological modules, becoming an intelligent puncture tool that "can see, can feel, and can think."
• Simulation training: With the development of virtual reality technology, novice doctors can repeatedly practice Veress needle punctures in VR simulators, experiencing the feel of various complex cases, thereby shortening the learning curve and reducing errors in real surgeries.

Conclusion

The story of the Veress needle is far from over. It is standing at the intersection of tradition and modernity. On one hand, we respect the classic method and continue to leverage its simplicity and reliability; on the other hand, we embrace innovation and actively embrace the higher safety brought by visualization and intelligence. The ultimate goal is simple: to make the "first needle" of every laparoscopic surgery safer, more precise, and more controllable.