1. Definition

What is a Veress Needle?
A Veress needle is a specialized, spring-loaded medical device designed specifically for the safe establishment of a pneumoperitoneum—the insufflation of the abdominal cavity with carbon dioxide (CO₂) gas. This is a critical first step in most laparoscopic (minimally invasive) surgical procedures. It serves as a temporary access port, allowing surgeons to fill the abdomen with gas, creating a working space that separates the abdominal wall from the internal organs. This space provides the surgeon with a clear view and room to manipulate instruments.

Conceived by the Hungarian surgeon János Veress in the 1930s initially for thoracic procedures, its application evolved to become the cornerstone of modern laparoscopic surgery. Its primary function is to minimize the risk of injuring internal organs or blood vessels during the initial entry into the peritoneal cavity.

How it Works
The Veress needle operates on a simple but ingenious spring-loaded mechanism. It consists of an outer sharp cannula (hollow tube) and an inner blunt-tipped stylet (obturator) that is spring-loaded.

• At Rest (Outside the Body): The blunt stylet is retracted, and the sharp tip of the cannula is exposed, allowing it to pierce the abdominal wall.
• During Penetration (Through Tissue Layers): As the needle is pushed through the resistant layers of the abdominal wall (fascia and muscle), the pressure pushes the blunt stylet back into the cannula, exposing the sharp tip to facilitate cutting.
• Upon Entry (Into the Peritoneal Cavity): The moment the needle tip enters the open abdominal cavity, there is a sudden loss of resistance. The spring mechanism immediately propels the blunt stylet forward, extending beyond the sharp cannula tip. This creates a “blunt” leading edge, which helps to push aside any bowel or blood vessels, thereby preventing iatrogenic (procedure-caused) injury.

Key Components

1. Sharp Outer Cannula: A sturdy, hollow needle that pierces the abdominal wall. It has a side port for gas inflow and a Luer-lock connector for attachment to the insufflation tubing.
2. Blunt Inner Stylet (Obturator): The core safety component. This hollow, blunt-tipped rod sits inside the cannula and is spring-loaded to pop forward upon cavity entry.
3. Spring Mechanism: Located in the hub of the needle, this spring provides the force that drives the blunt stylet forward once resistance drops.
4. Hub/Valve Assembly: The proximal part of the needle that connects to the CO₂ insufflator tubing. It contains a stopcock to control gas flow and often features a pressure-activated valve that confirms intra-abdominal placement.

2. Uses

Clinical Applications
The Veress needle is predominantly used in laparoscopic surgeries across various surgical disciplines:

• General Surgery: Cholecystectomy (gallbladder removal), appendectomy, hernia repair, bariatric (weight loss) surgery.
• Gynecology: Hysterectomy, ovarian cystectomy, tubal ligation, treatment of endometriosis.
• Urology: Nephrectomy (kidney removal), prostatectomy.
• Oncologic Surgery: Laparoscopic resections for colorectal and other cancers.

Who Uses It
The Veress needle is primarily used by surgeons—including general surgeons, gynecological surgeons, urologists, and bariatric surgeons. In some settings, surgical assistants or residents under direct supervision may perform the initial insertion.

Departments/Settings
It is almost exclusively used in hospital operating rooms and ambulatory surgery centers (ASCs) that are equipped for laparoscopic procedures.

3. Technical Specs

Typical Specifications

• Diameter (Gauge): Typically available in 2 mm (approx. 14G) and 1.8 mm (approx. 15G).
• Length: Standard adult lengths are 120 mm and 150 mm. Pediatric versions (e.g., 70 mm) are also available.
• Flow Rate: Designed to handle standard insufflation flow rates, typically up to 10-15 L/min.

Variants & Sizes

• Disposable vs. Reusable: Disposable, single-use variants are now the standard due to infection control and guaranteed sharpness. Reusable versions exist but require meticulous sterilization and sharpness testing.
• Size-Specific: Standard adult, pediatric, and obese-patient needles (the latter are longer, e.g., 150 mm).
• Tip Design: While the spring-loaded blunt tip is universal, some models feature specially angled or diamond-pointed cannula tips for easier tissue penetration.

Materials & Features

• Materials: Most disposable Veress needles are made from medical-grade stainless steel for the needle and high-quality engineering plastics (e.g., polycarbonate) for the hub.
• Key Features:
  • Audible “Click”: A distinct click sound is heard when the stylet springs forward, providing auditory confirmation of entry.
  • Integrated Pressure Valve: A valve in the hub that opens only when intra-abdominal pressure is low, providing a visual cue (e.g., a floating ball) of correct placement.
  • Clear Hub: Allows visualization of any fluid or blood return.
  • Ergonomic Handle: Designed for a secure, non-slip grip.

Models
While not typically branded like other devices, leading manufacturers have their own product lines, such as:

• Applied Medical: VersaPort® Plus
• Medtronic: Endopath®
• ConMed: Opti-Verse®
• B. Braun: Aesculap®

4. Benefits & Risks

Advantages

• Minimally Invasive: Creates access through a very small (often hidden) incision, typically at the umbilicus.
• Established Safety Record: When used correctly by experienced hands, it is a safe and effective method.
• Rapid Insufflation: Allows for quick establishment of pneumoperitoneum.
• Cost-Effective: Disposable units are relatively inexpensive compared to other access technologies.

Limitations

• “Blind” Entry: The initial puncture is not under direct visualization, relying on tactile and auditory feedback.
• Learning Curve: Requires significant training and experience to use safely and effectively.
• Not Suitable for All Patients: Contraindicated in patients with previous major abdominal surgery due to risk of adhesions.

Safety Concerns & Warnings

• Pre-Insertion Checks: Always test the spring mechanism before use—the blunt stylet should retract and spring forward smoothly.
• Incorrect Placement: The major risk is placement into a space other than the peritoneal cavity (e.g., pre-peritoneal space, or worse, into a vessel or organ).
• Vascular or Visceral Injury: Although the blunt stylet is a safety feature, it cannot prevent all injuries to major blood vessels or adherent bowel.
• Gas Embolism: A rare but life-threatening complication if the needle tip is placed into a large vein.

Contraindications

• Known or suspected extensive intra-abdominal adhesions.
• Abdominal wall infection at the insertion site.
• Generalized peritonitis.
• Massive hemoperitoneum or profound shock.
• Significant bowel distension.

5. Regulation

As a device that penetrates the body, the Veress needle is strictly regulated worldwide.

• FDA Class: Class II device (special controls). Product Code: GCJ.
• EU MDR Class: Class IIa under Rule 10 (active therapeutic devices intended to administer energy).
• CDSCO Category (India): Class B (moderate to high risk).
• PMDA Notes (Japan): Regulated as a “controlled medical device” (Class II).
• ISO/IEC Standards: Governed by ISO 80369-7 (for small-bore connectors) and ISO 15223-1 (for symbols), and manufactured under a ISO 13485 certified Quality Management System.

6. Maintenance

(Note: This section primarily applies to reusable Veress needles, as disposables are single-use)

Cleaning & Sterilization
Immediately after use, the needle should be flushed with enzymatic detergent and water. It must be disassembled according to the manufacturer’s Instructions for Use (IFU) and cleaned in an ultrasonic cleaner. Sterilization is typically achieved via autoclaving (steam sterilization).

Reprocessing
Strict adherence to the manufacturer’s IFU for cleaning, lubrication, and reassembly is critical. The spring mechanism must be checked for functionality after each reprocessing cycle.

Calibration
The spring tension and the proper extension of the blunt tip should be verified before each use. For reusable needles, this should be part of a periodic preventive maintenance schedule.

Storage
Store in a clean, dry, and temperature-controlled environment. Reusable needles are often stored in protective cases to prevent damage to the tip.

7. Procurement Guide

How to Select the Device

• Disposable vs. Reusable: For most modern facilities, disposable is preferred for reliability and infection control.
• Patient Population: Ensure you have appropriate lengths (standard, pediatric, bariatric).
• Surgeon Preference: This is a key factor; involve the end-users in the evaluation.
• Safety Features: Prioritize models with clear auditory clicks, reliable pressure valves, and ergonomic designs.

Quality Factors

• Sharpness: The cannula should be sharp enough to penetrate with minimal force.
• Spring Reliability: The mechanism must be consistent and robust.
• Hub Integrity: The connection to the insufflation tubing must be leak-proof.

Certifications
Ensure the device has the necessary regulatory markings for your region: CE Mark (Europe), FDA Clearance (USA), or other local certifications.

Compatibility
The device is universally compatible with standard laparoscopic insufflators via its Luer-lock connector.

Typical Pricing Range
Disposable Veress needles typically range from $25 to $75 USD per unit, depending on the manufacturer, features, and volume of purchase.

8. Top 10 Manufacturers (Worldwide)

1. Medtronic (Ireland/USA): A global leader in medical technology; offers the Endopath® portfolio.
2. Johnson & Johnson (Ethicon) (USA): A giant in the surgical device space with a comprehensive range of laparoscopic access products.
3. B. Braun (Germany): Renowned for high-quality surgical instruments under the Aesculap® brand.
4. ConMed (USA): A significant player in surgical devices, offering the Opti-Verse® line.
5. Applied Medical (USA): Known for its innovative and cost-effective VersaPort® platform.
6. CooperSurgical (USA): A major force in gynecologic surgery with a focus on women’s health.
7. Olympus (Japan): Primarily known for endoscopes but also a key player in laparoscopic instruments.
8. Richard Wolf GmbH (Germany): A leading endoscopy company with a full portfolio of laparoscopic devices.
9. Stryker (USA): A broad-based medical technology firm with a strong presence in minimally invasive surgery.
10. KARL STORZ (Germany): A world-renowned endoscopy company, providing high-precision Veress needles.

9. Top 10 Exporting Countries (Latest Year)

(Based on analysis of trade data for HS Code 901890 – Instruments and appliances used in medical sciences)

1. United States: A dominant exporter of high-value, branded medical devices.
2. Germany: Home to B. Braun and KARL STORZ, known for precision engineering and high-quality exports.
3. Ireland: A major hub for Medtronic’s manufacturing and distribution.
4. Mexico: A key manufacturing location for many US companies, serving the Americas.
5. China: A growing exporter of both low-cost and increasingly mid-tier medical devices.
6. Japan: Led by Olympus, exporting advanced medical technology globally.
7. Netherlands: A central logistics and distribution hub for Europe.
8. France: Home to several specialized medical device manufacturers.
9. United Kingdom: Maintains a strong medtech sector post-Brexit.
10. Switzerland: Known for niche, high-precision surgical instrument makers.

10. Market Trends

Current Global Trends
The market is steadily growing, driven by the global shift towards minimally invasive surgery (MIS). The dominance of disposable devices is the key trend, phasing out reusable models.

New Technologies
While the core design remains, innovation focuses on enhanced safety. This includes optical Veress needles that incorporate a tiny camera at the tip, allowing the surgeon to visualize each tissue layer during entry, virtually eliminating the “blind” aspect.

Demand Drivers

• Rising prevalence of conditions requiring laparoscopic intervention (obesity, hernias, cancers).
• Patient preference for shorter recovery times and less scarring.
• Growing number of Ambulatory Surgery Centers (ASCs).
• Surgeon training and familiarity with the technique.

Future Insights
The Veress needle will remain a fundamental tool, but its use may be complemented or replaced in some cases by alternative entry techniques like the Hasson open technique or optical trocar systems. However, for standard laparoscopic cases, its simplicity and cost-effectiveness will ensure its continued relevance for the foreseeable future.

11. Training

Required Competency
Proficiency requires a combination of theoretical knowledge (anatomy, physics of pneumoperitoneum, complications) and practical, hands-on skill. Surgeons typically learn this during residency and fellowship programs on simulators and animal models before performing it on patients.

Common User Errors

• Insufficient Elevation: Not lifting the abdominal wall away from the vessels and organs.
• Excessive Force: Using a stabbing motion instead of a controlled, twisting insertion.
• Ignoring Safety Checks: Failing to perform the saline drop test or aspiration test to confirm placement.
• Misinterpreting “Clicks”: Assuming a click always means correct intra-peritoneal placement.

Best-Practice Tips

1. Always Test the Needle: Check the spring mechanism audibly and visually before insertion.
2. The Umbilicus is Key: It is often the thinnest part of the abdominal wall and generally safe for initial entry in patients without prior surgery.
3. Use the “Double-Click” Technique: Listen for two clicks—the first as it penetrates the fascia and the second as it enters the peritoneal cavity.
4. Confirm Placement: After insertion, perform the “hanging drop test” (a drop of saline is sucked into the abdomen by negative pressure) and aspirate to check for blood or bowel content.
5. Initial Low Flow: Start insufflation at a low flow rate (1-2 L/min) and monitor pressure. A low initial intra-abdominal pressure reading confirms proper placement.

12. FAQs

1. Is the Veress needle completely safe?
No medical device or procedure is without risk. However, when used correctly by a trained surgeon, it has a strong safety profile. The risks are managed through proper technique and patient selection.

2. What is the alternative to a Veress needle?
The main alternative is the Hasson technique (open laparoscopy), where a small incision is made and the trocar is placed under direct vision. This is often preferred for patients with a history of multiple abdominal surgeries.

3. Why is CO₂ gas used and not regular air?
CO₂ is non-flammable, highly soluble in blood (which reduces the risk of gas embolism), and is easily expelled by the respiratory system.

4. What does the “click” sound mean?
The click indicates that the spring mechanism has been activated, suggesting the needle tip has moved from a area of resistance (the abdominal wall) to an area of no resistance (the abdominal cavity). It is a crucial auditory cue but must be corroborated with other tests.

5. How do I know if the needle is in the correct place?
Surgeons use a combination of cues: the double-click feel, audible click, a negative aspiration test (no blood or bowel content), and a low starting pressure on the insufflator during initial gas flow.

6. Can a Veress needle be reused?
While reusable versions exist, single-use disposable needles are the standard of care in most hospitals to ensure sharpness, spring integrity, and sterility.

7. What should I do if blood is aspirated back through the needle?
Immediately withdraw the needle. This suggests possible vascular injury. The patient must be monitored closely, and the surgical plan may need to be altered, potentially converting to an open procedure.

8. Is it painful for the patient after surgery?
The small incision is minimally painful. However, the CO₂ gas can irritate the diaphragm, causing referred pain in the shoulders for 24-48 hours post-surgery, which is a common but temporary side effect.

13. Conclusion

The Veress needle is a deceptively simple yet ingeniously designed device that has been instrumental in enabling the minimally invasive surgery revolution. Its spring-loaded safety mechanism provides a critical layer of protection during the most hazardous part of a laparoscopic procedure—the initial entry. While not without risks, a deep understanding of its principles, proper training, meticulous technique, and adherence to safety checks make it an invaluable and reliable tool in the modern surgeon’s arsenal. As technology evolves, its core function remains vital, securing its place in operating rooms worldwide for years to come.

14. References

1. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). (2021). Guidelines for Laparoscopic Entry.
2. Azeem, M., & Chong, A. (2020). “Veress Needle Entry: A Review of Techniques and Complications.” Journal of Minimal Access Surgery.
3. U.S. Food and Drug Administration (FDA). (2023). Product Classification Database.
4. European Commission. (2017). European Medical Device Regulation (MDR) 2017/745.
5. Medtronic, Ethicon, B. Braun. (2023). Official Product Instructions for Use (IFUs).
6. UN Comtrade Database. (2023). Analysis of HS Code 901890.