Techniques of pneumoperitoneum

Laparoscopic cholecystectomy has become the standard of care for symptomatic gallstone disease. One of the key steps in the procedure is to obtain pneumoperitoneum and insert the first trocar safely through the umbilicus. In our first 150 laparoscopic cholecystectomies, the pneumoperitoneum was obtained by inserting a Veress needle through the umbilicus, followed by blind insertion of the first trocar through the umbilicus. This was associated with several complications, including bowel laceration. Subsequently, we adopted the open laparoscopic technique described by Hasson in 1974. Using this, we have performed 150 laparoscopic procedures without complications. In this article, we compare and analyze the results and complications of both techniques. We find open laparoscopy to be a quicker, safer, and superior technique for obtaining pneumoperitoneum as well as a more cost-effective procedure.