Quality Management Response Letter

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Dear Members of the Quality Management Dept.,

Thank you for asking me to provide a response with additional information needed to complete your review of the issue of the case.

As to the indication for use of a previous surgical site for insertion of Veress needle this was chosen as this was the best site for the docking, and placement of the ports for the laparoscopic procedure to be completed. It is important to note that this was a previous laparoscopic incision site, i.e. a site of a 10 millimeters trocar. Thus in my experience of more than 25 years of performing laparoscopy surgery I have consistently used a previous laparoscopic incision sites doing redo laparoscopic surgery. Over this time I estimate that I have put in approximately twenty-thousand trocars for the thousands of patients that I operate on. It is rare to see adhesions at previously laparoscopic port site and therefore it is our standard health practice. As way of note this was off the midline in the left upper quadrant so it adhere …show more content…

Finally, review of the literature reveals in a systematic literature review they recommended that the veress needle not be inserted in the midline. They also note that vascular injuries could be fatally if not recognize.

In addition, we were asked to come in an identify the number attempts made for the insertion of veress needle per protocol we were off the midline and at a previous laparoscopic incision site and we attempted three times each time with a negative water drop test. Then we moved a little bit more lateral to a new incision site and at this time we attempted one time and were able to successfully place the veress needle and successfully do the water drop which indicated that the veress needle is free within the peritoneal cavity insufflation and place our additional

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