Do Clinical Experience and Surgical Technique Affect Outcomes in Initial Laparoscopic Trocar Placement? A Prospective Randomized Clinical Trial

Abstract

Aim: The aim of this study was to compare the intraoperative and postoperative complications of laparoscopic cholecystectomy by closed (supraumbilical Veress needle) versus open infraumbilical technique for initial, first port laparoscopic access. Patients and Methods: Our study included 560 adult patients, who were randomized into four groups (i.e., expert Veress, expert open, junior Veress, or junior open). Time for placement of the first trocar and time to complete the port-site closure were compared in all study groups. The mean operative time for cholecystectomy was compared after successful placement of the initial trocar until removal of the gallbladder. Intraoperative, early, and late postoperative complications were compared. Results: Duration of the initial port placement was significantly shorter among senior compared to junior surgeons. The Veress technique had a significantly shorter duration of port entry, but a longer duration of port-site closure compared to the open technique. Apart from the extraperitoneal insufflation incidents that were significantly more reported by junior surgeons, no significant differences in incidents were reported by senior and junior surgeons between open and closed techniques. Junior surgeons showed a better satisfaction with the open than the closed technique. Conclusions: Both the closed and open techniques for laparoscopic cholecystectomy are equally safe and effective for initial port-site entry whether performed by senior or junior surgeons. Junior surgeons are more satisfied with the open technique than the Veress needle technique, due to a perceived concern of injuring intra-abdominal structures. Therefore, junior surgeons would benefit from additional training during their residency to use both the techniques confidently.