DIRECT NEEDLE INSUFFLATION FOR PNEUMORETROPERITONEUM - ANATOMIC CONFIRMATION AND CLINICAL-EXPERIENCE

Objectives. The feasibility and safety of direct needle insufflation t o create pneumoretroperitoneum was assessed by an imaging study and cl inical experience. Methods. A total of 10 patients without previous re troperitoneal surgery or diseases received computed tomography scans o f the retroperitoneum 2 cm above the iliac crest. Distances between qu adratus lumborum and colon (Q-C distance) were measured in the supine and lateral positions. Changes of Q-C distance were calculated when th e patient was changed from the supine to the lateral position. Operati ve charts on 38 retroperitoneoscopic procedures were collected prospec tively to assess complications related to direct needle insufflation, which was performed by inserting a 14 G Veress needle blindly along th e posterior axillary line 2 cm above the iliac crest. Results. Q-C dis tance increased from 8.7 to 27.3 mm (left side) and 4.6 to 18.1 mm (ri ght side) when the patient was changed from the supine to the lateral position, both P values < 0.05. An average distance of 23 mm between c olon and quadratus lumborum was found when patients were lying lateral ly. The misplacement of a Veress needle was encountered in 1 patient, in which a prefascia insufflation resulted in conversion of the endosc opic procedure. Needle puncture caused no visceral or great vessel inj ury. Conclusions. Significant anterior movement of the colon was found when patients were changed from the supine to the lateral position. I t provided a window for inserting the Veress needle blindly into the r etroperitoneum. The high success rate (97%) and low complication rate of direct needle insufflation were found in actual clinical applicatio ns, We considered needle insufflation a safe and effective method of e stablishing a pneumoretroperitoneum for any retroperitoneoscopic proce dure. UROLOGY(R).