A total of 365 members (out of 3621) EAES members of whom all were, or used to be, practicing surgeons, responded. All depersonalized data can be found in supplemental file 2. In the following paragraphs, the highlights of the data is given.
General questions
The 85% male and 15% female respondents originated from 58 countries with the highest proportion from Italy (75), the Netherlands (23), and Romania (21). Regarding the age of the respondents, the largest group was found in the range of 31–40 years (124) followed by the range of 41–50 and 52–60 years with each 86 respondents (Fig. 1A). Most of the respondents had 6–10 years of experience followed by 11–15 years and 1–5 years of experience (Fig. 1B). When asked if sustainable hospital processes are important for the correspondent, the majority agreed (307) of which 196 strongly agreed (Fig. 1C). The vast majority of the 365 respondents claimed to use the Veress needle between 0 and 100 times (122) or more than 1000 times (88) (Fig. 1D). The remaining 155 respondents were divided over the rest of the group in much lower numbers. In total, 63.7% of the surgeons worked in a training hospital, 14.4% in a non-training hospital and 8.8% in a private clinic (Fig. 1E). From all respondents, 85.4% see themselves as early adapter, 25.2% as early majority and 14.7% as innovator (Fig. 1F). 82.4% of all respondents were right-handed and interestingly, more respondents were ambidextrous (12.2%) than left handed (5.4%) (Fig. 1G). From all respondents, 85% was Male and 14.7% Female (Fig. 1H).
Procedural questions
Independent from the type of approach, more than 50% of the respondents suggest that up to 20 trials are needed before the Veress Needle technique is mastered (Fig. 2A). The respondents think that a maximum overshoot of the Veress needle in the abdomen of 9.4 (SD5.5) mm is acceptable in order to use the system safely (Fig. 2B). There is a difference between respondents on how they handle obese patients during insufflation preparation and preparation location.
Of the responding surgeons, 68% reported that the recently developed Veress prototype with VeressPLUS safety mechanism can be beneficial for normal BMI, and 75% for high BMI patients (Fig. 2C,D). The survey showed that only 36% of the respondents think it is better to use the open method for normal patients, and 22% for high BMI. From the respondents, 72% were trained to use the Veress needle on the job, 5% in a skills lab and 23% from both (Fig. 2E). In this study, 51% indicated that they choose their preferred first access method after training, while 47% decided what worked best for them during practice (Fig. 2F). For patients with a normal BMI (15–25), the insertion area of choice was around the umbilicus for the majority of the respondents (68%) while for patients with a BMI higher than 25, this was the Palmer’s point (55%) (Fig. 2G,H). When asked if respondents have a preferred type of Veress needle, 86% confirmed (Fig. 2I). When asked if respondents have a preferred grip area (Fig. 2J), 37% answered that this is the shaft while 63% reported that they hold the Veress needle at its grip area during insertion (Fig. 3).
Figure 4A indicates that around 43% of the respondents confirmed that a high BMI is directly related to risk of complications, while 34% suggested that this is not the case. The rest of the respondents (21%) were neutral. When asked if a reduction in overshoot can reduce the risk of complications, 87% agrees, of which 56% strongly agrees, 34% answered neutral and only 7% suggest that this is not the case (Fig. 4B). When asked if a reduction in a learning curve for a new technology can decrease the risk of complications, 37% agrees, 42% answered neutral and 21% suggests that this is not the case (Fig. 4C).
VeressPLUS questions
When asked if the respondents think a Veress needle that reduces overshoot like the proposed prototype with integrated VeressPLUS safety mechanism [5], should be used on patients with normal BMI, 70% agrees, of which 43% strongly agrees, 16% answered neutral and 14% do not agree (Fig. 5A). When asked if the respondents think a Veress needle that reduces overshoot should be used on patients with a high BMI, 76% agreed, of which 51% strongly agreed, 13% answered neutral and 10% disagree (Fig. 5B). In the last item of the survey, in which asked whether the respondents wished to join the VeressPLUS R&D collaborative project as an innovator or early adaptor, 61% agreed, 25% was open to it and answered “maybe” while 14% was not interested at all (Fig. 5C).
Correlation
Table 2 shows that only the question outcomes for “Age” and “years of experience” of the questionnaire were strongly related with a correlation coefficient of 0.94. Also the question outcomes for “If the above claims are true would you consider using a new needle with VeressPLUS safety mechanism in patients with a normal BMI” and “If the above claims are true would you consider using this new needle with VeressPLUS safety mechanism in patients with a normal BMI” were strongly correlated with a correlation coefficient of 0.66. The questions “years of experience” and “estimated number of Veress needle use” showed a medium correlation coefficient of 0.35 while the questions “Age” and “estimated number of Veress needle use” showed a medium correlation coefficient of 0.34. Another medium correlation of 0.33 was found between the question outcome “decrease in overshooting increases the overall safety” and “decreasing the learning curve of Veress needle increases the overall safety of closed entrée techniques”. The rest of the questions were not or only weakly related.