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

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Introduction

The Veress needle is a specialized abdominal puncture instrument equipped with an integrated safety mechanism. It consists of a spring-loaded inner stylet and an outer cannula, and is traditionally employed for establishing pneumoperitoneum in laparoscopic and other minimally invasive abdominal procedures.

The clinical case presented in this paper explores an innovative and skillful adaptation of the Veress needle - its application in the aspiration of giant ovarian cysts under gasless laparoscopy. This technique is characterized by its simplicity, operational convenience, and effective aseptic control, and importantly, it qualifies as a tumor-free (no-touch) surgical technique​ that minimizes the risk of intraoperative tumor cell spillage and seeding.

1. Operative Technique

1.1 Patient Positioning and Anesthesia

Following successful epidural anesthesia, the patient is placed in the lithotomy position. The surgical field is prepared using standard sterile draping and disinfection protocols. The operating microscope is suspended and positioned horizontally, supported by the surgeon's four fingers beneath the umbilicus to ensure stable visualization.

1.2 Incision and Exposure

A longitudinal incision​ is made along the upper edge of the umbilicus​ to allow initial entry and microscopic observation of the abdominal cavity.

A second 2 cm longitudinal incision​ is created in the mid-lower abdomen. This incision is carefully protected with wound drapes to maintain a sterile field.

1.3 Cyst Stabilization

The anterior wall of the ovarian cyst is sutured using 3-0 absorbable suture material, which serves a dual purpose: it provides traction​ to stabilize the cyst and helps elevate the cyst wall​ toward the incision, facilitating controlled puncture.

1.4 Veress Needle Aspiration - The Core Step

The Veress needle is firmly connected to a 20 ml syringe​ and introduced into the abdominal cavity through the lower abdominal incision. Under direct microscopic guidance, the needle is advanced to puncture the cyst wall, enter the cystic cavity, and begin aspirating the cystic fluid.

Critical operational detail - the built-in valve control:

After aspirating 20 ml​ of cystic fluid, the Veress needle's integrated on-off switch is closed​ before the syringe is detached. This prevents any backflow or leakage of fluid along the needle shaft.

The syringe is then disconnected, emptied, and reattached to continue the aspiration cycle. To maximize efficiency, two 20 ml syringes may be prepared on the instrument table for alternating use, minimizing downtime between aspiration cycles.

The aspirated fluid is either collected in a dedicated sterile container​ for pathological analysis or directly channeled into the suction canister​ via the operating room's vacuum system for safe disposal.

1.5 Wound Closure

Once the cystic cavity is completely evacuated, the puncture site on the cyst wall is closed with sutures​ to seal the cavity. Meticulous hemostasis​ is achieved throughout the operative field. After the standard sponge and instrument count​ is confirmed correct, the abdominal wall is closed in layers. The skin is approximated with suture material that does not require removal​ (e.g., absorbable subcuticular stitches or adhesive closure).

2. Advantages of the Veress Needle in This Application

2.1 Superior Safety Profile

The Veress needle is engineered according to the classic Veress design principle. Its key safety features include:

The distal end of the inner stylet is blunt-tipped​ and equipped with lateral side-ports, enabling multidirectional fluid aspiration, gas insufflation, and irrigation.

A spring mechanism​ is housed within the needle hub. When the needle encounters resistance while puncturing the cyst wall, the stylet retracts into the sharp outer sheath, preventing the exposed sharp tip from inadvertently damaging adjacent normal tissues.

Once the needle enters the cystic cavity, resistance disappears, and the spring force automatically deploys the blunt stylet forward, allowing safe and controlled aspiration without the risk of the outer sheath lacerating healthy structures.

This self-regulating safety mechanism makes the Veress needle inherently safer than conventional sharp aspiration needles in the confined and variable anatomy of a giant ovarian cyst.

2.2 Aseptic and Tumor-Free (No-Touch) Technique

The Veress needle's unique integrated switch-valve design​ allows the operator to control the outflow of cystic fluid with precision. By closing the valve before disconnecting the syringe, the operator can:

Fully maintain the sterility of the operative field;

Prevent spillage of cystic fluid​ onto surrounding peritoneal surfaces;

Avoid tumor cell implantation and seeding​ along the puncture tract or within the abdominal cavity.

This makes the technique fully compliant with sterile surgical principles and tumor-free (no-touch) oncological standards​ - a critical consideration in any ovarian mass where malignancy cannot be preoperatively ruled out.

2.3 Ergonomic and Functional Design

The lateral side-ports​ on the Veress needle stylet facilitate multidirectional aspiration. By simply rotating the needle body, the operator can access fluid from different angles within the cyst cavity, ensuring more complete and thorough evacuation.

In contrast, conventional abdominal puncture needles feature a single-bevel slanted tip. Achieving the same multidirectional suction would require large-angle adjustments of the needle orientation, which risks enlarging the puncture hole in the cyst wall​ through repeated angle changes or multiple puncture attempts - a scenario that greatly increases the likelihood of cystic fluid leakage and intra-abdominal contamination.

The Veress needle's rotational flexibility eliminates this problem, allowing the operator to reposition the aspiration angle without withdrawing or re-puncturing, thereby maintaining a sealed, controlled system throughout the procedure.

2.4 Optimal Specifications for Clinical Versatility

Key comparative advantages of the Veress needle:

Length versatility: With six length options ranging from 60 mm to 180 mm, the Veress needle can be matched to patients of different body habitus and cysts of varying sizes, as well as adapted to different patient positions (lithotomy, supine, etc.). The conventional abdominal puncture needle's fixed 35 cm length is often unnecessarily long for this application, making it cumbersome and difficult to stabilize.

Larger inner and outer diameters: The thicker needle tube (up to 3.0 mm outer diameter) allows for higher-volume, faster aspiration​ and is significantly less prone to clogging​ when dealing with viscous or protein-rich cystic fluid. The fine 1.2 mm diameter of the conventional needle is a major disadvantage when aspirating thick fluid.

Safety and stability: The Veress needle's protective sheath mechanism and non-slip tail grip enhance operator control, stability, and safety​ - critical factors during delicate manipulation within the abdominal cavity.

3. Summary

The application of the Veress needle as a dedicated aspiration device for abdominal cysts​ - particularly in the context of gasless laparoscopic surgery for giant ovarian cysts​ - offers compelling advantages:

✅ Safer and more convenient operation

✅ Reliable, efficient fluid evacuation

✅ Full compliance with aseptic and tumor-free surgical standards