Transfundal insertion of a Veress needle in laparoscopy of obese subjects:a practical alternative

Because induction of artificial pneumoperitoneum through the infra-umbilica l route is associated with complications in laparoscopic procedures, especi ally in obese patients, we performed a prospective randomized study compari ng the conventional infra-umbilical route with a transfundal route, in whic h the Veress needle is inserted into the peritoneal cavity through the uter ine fundus, One hundred obese subjects (body mass index greater than or equ al to 25 kg/m(2)) scheduled for laparoscopic sterilization were randomized into two groups. In the infra-umbilical group pneunoperitoneum was achieved at a ratio (punctures/pneumoperitoneum) of 56/49 (1.14), There was one fai lure in this group. In the transfundal group the ratio was 53/51 (1.04). Th ere was no clinically significant bleeding in either of the groups; nor wer e there any major complications. One subject in whom the infraumbilical rou te failed was moved to the transfundal group. This subject also underwent d ilatation and curettage at the time of laparoscopy, Postoperatively she con tracted chlamydial pelvic inflammatory disease. No other infections were de tected postoperatively in either of the groups, In conclusion, the transfun dal route of inducing artificial pneumoperitoneum proved to be easy, safe a nd effective.