Comparison of Veress needle and direct trocar technique during laparoscopic initial entry via Palmer's point

In laparoscopic surgery, initial entry into the abdomen becomes more risky in patients with a history of abdominal surgery. In such cases, initial entry is usually performed with a Veress needle via Palmer's point (PP). However, it is associated with an increased failure rate, especially in obese patients. On the other hand, direct trocar entry is a convenient and safe technique with a low failed entry rate. Direct trocar entry via PP may be the preferred approach for initial abdominal entry in patients with a history of abdominopelvic surgery.

The present study included 438 patients with a previous history of abdominopelvic surgery undergoing laparoscopic gynecological surgery, during which two different entry techniques via PP were tested.

There were 88 patients (20.1%) in the Veress needle group and 350 patients (79.9%) in the direct trocar group. The time to create a pneumoperitoneum was significantly shorter in the direct trocar group (P < 0.001). Successful entry was achieved at the initial attempt in 78 patients (88.6%) from the Veress needle group and in 347 patients (99.1%) from the direct trocar group (P = 0.012). Minor complication rates were similar in both groups. However, one major complication was observed in the direct trocar group, while no major complications were noted in the Veress needle group.

Provided that the basic surgical principles are respected, direct trocar entry technique via PP is a safe, effective, and fast initial entry approach into the abdomen and may be preferred in patients with previous abdominopelvic surgery.