The curious case of the missing Veress needle beveled outer sheath

Abstract

This incident occurred during a laparoscopic sterilization camp in Bhongir more than four decades ago. The camp operated with four operating tables functioning simultaneously, each staffed by a surgeon and an assisting nurse. To maintain the rapid workflow, laparoscopic scopes and Veress needles were continuously cleaned, sterilized and immersed in Cidex solution for 10-15 minutes in accordance with the prevailing protocol. Those who have participated in such sterilization camps will readily understand the operational procedures and working environment involved. The first lady who had the X-ray, the 12 cm long Veress needle with the sharp beveled edge was in the abdomen. In Bhongir Government hospital got the theatre sterilized, the anaesthetist with Boyles apparatus and the surgeon had come in the ambulance from Nalgonda. The author could have performed the laparotomy, but thought it better to have a surgeon in case of any eventuality. There was apprehension to shift her in an ambulance to Hyderabad, with the needle with beveled edge in her abdomen. The Veress was identified in the abdomen by 3:30 pm and a laparotomy was performed at 8:30 pm. The patient was in a stable condition. The needle was covered by omentum and near the left paracolic gutter below the splenic flexure. The needle and part of the omentum covering it were excised. The outer sheath got broken from the handle, the handle was with the inner stylet. The patient made good postoperative recovery. Antibiotic coverage was given prior to laparotomy.