[Safety of direct entry in laparoscopy: Results from a large single-center series]

Introducing the first trocar is a crucial stage in laparoscopy, accouting for 50% of complications. Currently, three main techniques are used in gynecological surgery: Veress needle, open laparoscopy and direct trocar insertion. Despite the low risks described in the literature, direct trocar insertion remains the least-used technique. The primary endpoint of our study is to demonstrate the safety of direct trocar insertion by studying complications related to the initial trocar insertion among the main three laparoscopic entry techniques. Secondary endpoints are analysis of the choice of the technique according to the patient, the type of surgery and the evolution of practices over time.

It is a retrospective observational single center study, which included patients undergoing laparoscopy for gynecologic surgery from 2010 to 2022 with one of these entry techniques: Direct trocar insertion, Veress needle or open laparoscopy.

Among the patients, 5504 undergoing laparoscopics interventions were included: 2644 with the Veress needle (48%), 2501 Direct trocar insertion (46%) and 359 Open techniques (6%). No vascular wound was noted for either Direct trocar insertion or Open technique, compared with 3 for Veress needle. No visceral injury was found for any of the three methods. There was no more abdominal complications in high-risk patients for any of the three techniques.

Direct trocar insertion is not associated with an increase in abdominal complications compared to other techniques. These results suggest that this technique appears to be safe in our experience, including in high-risk patients.