Open versus closed method of establishing pneumoperitoneum for laparoscopic cholecystectomy

To compare the efficacy and safety of the Hasson cannula (open) and Veress needle (closed) method to gain access in the abdominal cavity for laparoscopic cholecystectomy.

Randomized controlled study.

Ward 26, Jinnah Postgraduate Medical Centre, Karachi, from January to December 2007.

All patients undergoing laparoscopic cholecystectomy during the study period were enrolled. Younger (< 20 years) and elderly (> 65 years) patients and those with co-morbid conditions were excluded. The remaining were randomized into two study groups. In one group, the Hasson cannula was used, while in the other Veress needle was used to establish pneumoperitoneum. Surgeries were performed by experienced surgeons of the ward. Variables comparing the safety and efficacy of the two methods were studied.

There were a total of 60 patients in each group. In the Hasson cannula group 15 (25%) had complications of gas leakage, one developed a port-site hematoma and two patients developed wound infections. No complications occurred in the Veress needle arm. The mean access time in the Hasson cannula group (4.6+/-1.1 minutes) was less than that of for the Veress needle arm (5.4+/-0.7 minutes). Complications of visceral or vascular injury, port-site hernia or gas embolism did not occur in either arm.

Although complications occurred using the Veress needle technique, the Hasson cannula technique was faster. Further studies on larger sample sizes are necessary to establish corroborative evidence and formulate guidelines.