OBJECTIVE: Abdominal entry is a key initial step in laparoscopic surgery, with the Veress technique being a commonly used method. Proper placement of the Veress needle prior to insufflation is vital to avoid complications, and opening pressure (OP) is one method to verify correct placement. Elevated opening pressure can indicate improper placement; specifically, pressures above 8mmHg are correlated with misplacement. However, the effect of body mass index (BMI) on expected OP has not been well studied. This study aimed to evaluate OP during Veress needle insertion across different BMI categories.

METHODS: Patients undergoing laparoscopic procedures from June 2024 to March 2026 were screened. Inclusion criteria were age >18 years and Veress needle entry; exclusion criteria included prior abdominal surgery, abdominoplasty, or alternative entry methods. A total of 99 patients were enrolled and divided into three BMI groups: Group 1 (<25, n=33), Group 2 (25–29.9, n=33), and Group 3 (≥30, n=33). Informed consent was obtained, and the study was approved by the Maimonides Medical Center IRB. Standard laparoscopic protocols were followed, with the Veress needle inserted at the umbilicus in the dorsal lithotomy position. OP was recorded immediately via the insufflation system.

RESULTS: Mean OPs were 3.2 ± 1.83 mmHg for Group 1, 4.7 ± 1.85 mmHg for Group 2, and 5.82 ± 1.49 mmHg for Group 3. Differences were statistically significant (p < 0.001, Kruskal-Wallis and ANOVA), with post-hoc Tukey analysis confirming that all groups differed significantly from each other (p < 0.001).

CONCLUSION: OP increases with BMI, showing a clear positive correlation between BMI category and Veress needle OP. These findings suggest that BMI-adjusted OP thresholds may improve accuracy in