Abstract
Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy.
 Design: Randomized controlled trial
 Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020.
 Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant.
 Results: The complication rate in VNI group were significantly greater than the DTI group (p < 0.01), the duration of surgery between the two groups was not significantly different (p > 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p < 0.001).
 Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.
Highlights
Evolution of laparoscopic surgery started in 1910, when a Swedish surgeon Jacbeus performed a first laparoscopic surgery
The current RCT was an attempt to assess the efficacy and safety level of direct trocar insertion versus veress needle insertion techniques to create a successful pneumoperitoneum with minimum complications, so that we can develop some local guidelines for junior surgeons
Group A contained 304 patients in which the pneumoperitoneum was created through direct trocar insertion (DTI) and Group B had same number of age and sex matched patients undergone veress needle insertion (VNI)
Summary
Evolution of laparoscopic surgery started in 1910, when a Swedish surgeon Jacbeus performed a first laparoscopic surgery. Laparoscopic surgery has many beneficial effects as compared to the conventional surgical methods such fewer number of attempts to create pneumoperitoneum, cost effectiveness and cosmetic benefits. It is superior the open procedures but still has complications during the creation of pneumoperitoneum. Literature showed none of the technique clearly indicate the beneficial effect over the others Mostly it is decided by the surgeon at the time of operate which technique should be adopted. The current RCT was an attempt to assess the efficacy and safety level of direct trocar insertion versus veress needle insertion techniques to create a successful pneumoperitoneum with minimum complications, so that we can develop some local guidelines for junior surgeons
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