Related Experiment Video
Updated: May 3, 2026
Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
Published on: June 25, 2013
Does the abdominal entry method in laparoscopy really matter? A network meta-analysis of rare events in randomized
Barbara Gardella1, Mattia Dominoni1, Chiara Cassani1
1Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy; Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Objective:
To evaluate the risk of major injuries associated with Veress, open (Hasson), direct and optical abdominal entry methods in laparoscopy.
Methods:
Network meta-analysis was performed using penalized logistic regression. Pairwise meta-analysis was carried-out using Bayesian binomial-normal hierarchical models with weakly informative priors. Risk of bias was evaluated by ROB-2 method. NMA protocol was recorded in PROSPERO (n. CRD42024583526).
Results:
Vascular lesions occurred in 14/2832 of Veress, 1/1661 of direct, 2/426 of optical and 0/2030 of open entry methods in 26 studies of 7250 laparoscopies. In NMA, direct and open entry methods were associated with a reduced risk of vascular lesions compared to Veress (OR = 0.17,95 %CI = 0.04-0.67 and OR = 0.09,95 %CI = 0.01-0.68,respectively). Overall, pooled rates of major injuries were 0.76/1000 (95 % CI = 0.06-2.05) in 29 studies of 7584 subjects. Major injuries were less common in direct as compared to either Veress (OR = 0.21,95 %CI = 0.08-0.56) or open method (OR = 0.23,95 %CI = 0.07-0.73). According to a ranking evaluation of absence of major complications, direct entry (SUCRA = 84.3 %) had the highest cumulative proportion of success, followed by optical entry (SUCRA = 68.5 %). Minor complications including extraperitoneal insufflation, multiple attempts, omental injury, trocar bleeding or infection or incisional hernia were studied in a network of 8984 subjects in 33 studies with a pooled prevalence of 30/1000 (95 %CI = 26.7-34.7). The risk of minor injuries was lower in direct (OR = 0.33,95 %CI = 0.23-0.46) as opposed to Veress entry. Direct entry was also the method with the lowest cumulative proportion of minor injuries (SUCRA = 97.75).
Conclusion:
The open entrance method prevents vascular but not visceral injury. Overall, direct entry into the abdomen causes fewer severe and minor complications than Veress. In a hierarchy of procedures with fewer complications, direct entrance ranks first among the four most common methods of abdominal entry to establish pneumoperitoneum.
Related Concept Videos
01:18Effects of EDTA on End-Point Detection Methods
In the visual method, metal-ion indicators (metallochromic dyes), which have distinct colors in their free and complex forms, are added to the mixture to signal the titration's end point. They form stable complexes with metal ions, but these complexes are weaker than the corresponding metal–EDTA complexes. As a...
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:30Serum Laboratory Studies, Stool Test, Breath Test
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:30Methods to Assess Microbial Populations