Criação do pneumoperitônio mediante punção com agulha de Veress no hipocôndrio esquerdo: ensaio clínico, prospectivo e randomizado

• Autor(a) principal: Azevedo, Otávio Cansanção [UNIFESP]
• Data de Publicação: 2005
• Outros Autores: Azevedo, João Luiz Moreira Coutinho [UNIFESP], Sorbello, Albino Augusto, Godoy, Antônio Cláudio de, Menezes, Francisco Julimar Correia de [UNIFESP], Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0100-69912005000500011; http://repositorio.unifesp.br/handle/11600/2689
• topic: Laparoscopy; Surgical procedures, Operative; Pneumoperitoneum, Artificial; Biopsy, Needle; Laparoscopia; Procedimentos cirúrgicos operatórios; Pneumoperitônio artificial; Biópsia por agulha

BACKGROUND: In the creation of the pneumoperitoneum with the Veress neddle, all reported incidents occurred during the puncture in the midline of the abdomen. Albeit rare, such type of incident has a high mortality rate as it normally severs the large vessels. The objective of this research is to test the efficacy of a safer alternative method of puncture in the left hipocondrium. METHODS: Sixty two patients, distributed randomly into two groups were studied. Group HE: puncture in the left hipocondrium (n = 30), and Group LM: puncture in the medline of the abdomen (n = 32). An evaluation was carried out of the results of the tests as to the positioning of the needle, the number of failed attempts to access the peritoneal cavity and the time taken for the creation of the pneumoperitoneum. Real flows, intraperitoneal pressure, and injected volumes were recorded at 20 second intervals, until pressure had reached 12mmHg. RESULTS: The results of the test regarding the positioning of the Needle were equally positive. There were two unsuccessful attempts at piercing in Group LM and one in Group HE. The time taken for the creation of the pneumoperitoneum was on average of 3 minutes and 46 seconds for Group HE and of 4 minutes and 2 seconds for Group LM. The average measures recorded regarding flow, pressure and volume were equivalent in each Group, respectively. The statistical analysis has demonstrated that piercing of the left hypocondrium was as effective in the creation of the pneumoperitoneum as it was the case as regards the piercing of the medium line of the abdomen. CONCLUSION: The left hipocondrium must be the preferred place for the puncture with the Veress needle so as to create the artificial pneumoperitoneum by the closed technique, as it entails a smaller risk.