June 5th, 2020

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The Pulsatile Sign Confirms Intraperitoneal Entry During Closed Laparoscopic Surgery
Authors:  Taonei Mushayandebvu, M.D., and Parita Sahani, D.O.
  OBJECTIVE: To test the hypothesis that palpable pulsations lasting at least 60 seconds confirm intraperitoneal placement of the Veress needle.

STUDY DESIGN: A prospective clinical trial of 109 consecutive women undergoing laparoscopic surgery for benign gynecological disorders. A positive pulsatile test was defined as the presence of palpable pulsations in the insufflation tubing lasting at least 60 seconds on connecting to an inserted Veress needle. Absence of pulsations or pulsations lasting <60 seconds was considered a negative test.

RESULTS: Overall, the sensitivity of the pulsatile test was 100%, with a specificity of 100% and positive predictive values and negative predictive values of 100%.

CONCLUSION: Our data demonstrate that the Pulsatile test is reliable in determining both the correct and incorrect position of the Veress needle, at least in this low-risk group.
Keywords:  abdominal wall, anatomic landmarks, body mass index, gynecologic surgical procedures, iatrogenic disease, insufflation, laparoscopy, peritoneal cavity, pneumoperitoneum, probability, prospective studies, umbilicus, vascular system injuries, Veress needle
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