Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Background:

• Pneumoperitoneum creation is essential for laparoscopic procedures.
• Veress needle insertion is a traditional method for achieving pneumoperitoneum.
• Direct trocar insertion offers an alternative approach.

Purpose of the Study:

• To compare the safety and efficacy of direct disposable shielded trocar insertion versus Veress needle insertion for pneumoperitoneum during laparoscopic cholecystectomy (LC).
• To assess complication rates associated with each technique.

Main Methods:

• A comparative study involving 1,500 patients undergoing LC.
• Pneumoperitoneum was achieved using either Veress needle (470 patients) or direct trocar insertion (1,030 patients).
• Exclusion criteria included patients requiring open trocar insertion.

Main Results:

• The complication rate was significantly lower with direct trocar insertion (0.9%) compared to the Veress needle group (14%).
• Major complications, including gastric perforation and iliac artery laceration, occurred exclusively in the Veress needle group.
• P-value < 0.01 indicated statistical significance.

Conclusions:

• Direct disposable trocar insertion is a safe and effective alternative to Veress needle insertion for creating pneumoperitoneum.
• This technique offers advantages such as reduced complications, lower cost, and faster pneumoperitoneum creation.
• The findings support the adoption of direct trocar insertion in laparoscopic cholecystectomy.