The pressure profile test is more sensitive and specific than Palmer's test in predicting correct placement of the Veress needle.

NMUH Staff Publications

152

<p style="margin: 0px 0px 0.5em; line-height: 17.999801635742188px;"><span style="font-size: 8pt;"><strong>OBJECTIVES:</strong> Although the majority of laparoscopic complications result from improper <span class="highlight">Veress</span> <span class="highlight">needle</span> <span class="highlight">placement</span>, the safety tests commonly used to determine <span class="highlight">correct</span> <span class="highlight">placement</span> are not always reliable. A prospective observational study (Canadian Task Force Classification II-2) was set up to determine the reliability of <span class="highlight">Palmer's</span> and <span class="highlight">pressure</span> <span class="highlight">profile</span> tests in <span class="highlight">predicting</span> the<span class="highlight">correct</span> intraperitoneal <span class="highlight">placement</span> of the <span class="highlight">Veress</span> <span class="highlight">needle</span> prior to insufflation.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;"><span style="font-size: 8pt;">STUDY DESIGN:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 17.999801635742188px;"><span style="font-size: 8pt;">One hundred consecutive women undergoing gynaecological laparoscopic surgery between September 2006 and June 2007 were recruited. The operating surgeons conducted <span class="highlight">Palmer's</span> and <span class="highlight">pressure</span> <span class="highlight">profile</span> tests in all 100 cases and recorded the ease with which these tests were performed and whether or not they felt that the <span class="highlight">needle</span> <span class="highlight">placement</span> was <span class="highlight">correct</span>. They were also asked to comment on the saline drop <span class="highlight">test</span> and double click acoustic <span class="highlight">test</span> if appropriate.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;"><span style="font-size: 8pt;">RESULTS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 17.999801635742188px;"><span style="font-size: 8pt;">The overall sensitivity of <span class="highlight">Palmer's</span> <span class="highlight">test</span> was 0.92 while its specificity was 0.5. The overall sensitivity and specificity of the <span class="highlight">pressure</span> <span class="highlight">profile</span> <span class="highlight">test</span> were 0.99 and 0.75, respectively, making this a <span class="highlight">more</span> reliable <span class="highlight">test</span> for <span class="highlight">predicting</span> intraperitoneal<span class="highlight">placement</span> of the <span class="highlight">Veress</span> <span class="highlight">needle</span>.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;"><span style="font-size: 8pt;">CONCLUSIONS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 17.999801635742188px;"><span style="font-size: 8pt;">The <span class="highlight">pressure</span> <span class="highlight">profile</span> <span class="highlight">test</span> was a <span class="highlight">more</span> reliable guide to confirming the <span class="highlight">correct</span> <span class="highlight">placement</span> of the <span class="highlight">Veress</span> <span class="highlight">needle</span>as a negative <span class="highlight">test</span> is <span class="highlight">more</span> likely to indicate failure to achieve intraperitoneal <span class="highlight">placement</span>.</span></p>