Postinsufflation Optical Entry via Veress Access in the Left Upper Quadrant: Safety and Outcomes

Conventional closed-entry approaches typically employ either Veress needle insufflation followed by blind trocar insertion, or optical trocar entry without prior pneumoperitoneum. The safety, feasibility, and outcomes of optical entry after establishment of pneumoperitoneum using Veress needle, is not adequately established in published literature.

We hypothesize that Veress access left upper quadrant optical entry (VALO) technique of post-Veress insufflation optical entry is safe, effective, and feasible for routine peritoneal access in laparoscopic surgery.

A retrospective single-center cohort study of all consecutive cases undergoing cholecystectomy by a single surgeon using the VALO technique as the routine initial method of peritoneal access, between July 2022 and April 2025, was conducted. Primary outcomes included success rate and access-related complications. Secondary outcomes included operative time, 30-day morbidity, mortality, and readmission rates.

A total of 124 patients were included, with 81 (65.4%) being female. The median age was 48.5 years. The mean body mass index (BMI) was 32.3 kg/m², and 51.6% had previous abdominal surgery. Urgent cases accounted for 67% of procedures. Peritoneal access using VALO was successful in all patients (100%). There were no access-related vascular or visceral injuries, and no conversions were needed due to entry complications. Thirty-day outcomes showed no mortality, reoperations, or incisional hernias. The readmission rate was 5.6%, and none of these were related to access complications.

The VALO technique of Left upper quadrant postpneumoperitoneum optical entry is safe, feasible, and effective for initial peritoneal access in laparoscopic surgery, including patients with prior abdominal surgery.