Closed access techniques for initial peritoneal entry in laparoscopic surgery: Veress needle versus direct trocar access
- Author Dr. Rajive Gupta
- Co-Author Dr. Ritvik Resutra, Dr. Madhu Gupta
- DOI 10.17605/O
- Country : India
- Subject : Surgery
Keywords : Closed technique; Direct trocar access; Laparoscopy; Pneumoperitoneum; Port; Umbilicus; Veress needle
Abstract
Background and Aims: In laparoscopic surgery, initial peritoneal access is a blind procedure & can lead to many complications. In this study, initial peritoneal access by the veress needle technique has been compared with direct trocar access technique in terms of complications & efficiency.
Material and Methods: 2400 laparoscopic operations performed by the closed technique of access in the peritoneal cavity over a period of 10 years between April 2011 and May, 2021 were evaluated in this study. Two groups of the patients were made (A & B). Group A consisting of 1200 patients in whom initial peritoneal access was made by the veress needle & Group B consisting of 1200 patients in whom initial peritoneal access was made by direct trocar.
Results: At an average, peritoneal access took 25 seconds in Group A & 15 seconds in Group B. In Group A, 7 (0.58%) patients developed major complications in the form of bowel & major vascular injuries, whereas in Group B, small gut injury occurred in 3 patients & there was no major vessel injury. In group A, mortality rate was 0.25%, whereas in group B, mortality was 0%.
Conclusion: Many techniques have been introduced to eliminate laparoscopic access complications. There is not a single technique without complications, still the most common technique used for laparoscopic access is the veress needle, though access by direct trocar is quick, safe & efficient.
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