Aims: To compare direct trocar (DT) to Veress needle (VN) entry for creation of pneumoperitoneum at laparoscopy regarding the duration of the procedure, volume of gas consumption, ease of performance and frequency of complications.
Design: A randomized clinical trial
Subjects and Methods: One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either direct trocar entry (group A=500) or Veress needle (group B=500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon.
Outcomes: Duration of the procedure, volume of gas consumption, ease of performance and frequency of complications
Results: Patients in the two groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group (A ) than in group (B) (2.2±0.7)(95% confidence interval [CI] ,2.14–2.26 ) Vs 8.2±1.4(95% CI ,8.08-8..32 ) minutes, respectively, p<0.0001 .The mean gas consumption was significantly less in group (A) than in group B (2.6±0.9 {59% CI, 2.52-2.68}Vs 8.4±2.6({59% CI,8.17-8.63 }liters, respectively, p<0.0001. No major complications in both groups were encountered. Minor complications were significantly less in DT (0.4%, 59% CI,0.77-3.23) than in VN group (14%,95%CI 10.96-17.04), p<0.0001.
Conclusions: Direct trocar entry is a safe alternative to Veress needle entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.