The efficacy of direct trocar versus veress needle method as a primary access technique in laparoscopic cholecystectomy

Abstract

Objective: The objective of this study was to compare the safety and efficacy of direct trocar method and veress needle as the primary entry technique to establish pneumoperitoneum. Study Design: This was a randomized controlled study. Patients and Methods: A randomized controlled study was done on 150 patients who complained from gallstones and attended to our surgical team, from the period of May 1, 2013 to May 31, 2017, the patient age range was 19–65 years with a mean age of 41 ± 0.9 years, after confirming the diagnosis of gallstones, informed consent was obtained from the patients. Those with previous abdominal surgery or serious comorbidities were excluded from the study. A total of 150 patients were divided randomly with 75 patients had the access into their abdomen by veress needle and the other 75 patients by direct trocar method. Variables comparing the safety and efficacy of the two methods were studied. Results: Direct trocar method was faster (2.3 ± 1.1 standard deviation [SD] min) than veress technique (5 ± 0.9 SD min), CO2leak occurs just in one case of trocar method while it does not occur in veress technique, extraperitoneal insufflations occur in four cases (5.3%) operated by veress method, and only in one case of direct trocar method, port site infection develops in two cases (2.6%) of direct trocar method and in single case of veress cannula. Only one case of port site hematoma occurs in direct trocar method. Conclusion: Direct trocar method is a safe, fast, and easily done technique for the establishment of primary entrance into the peritoneal cavity and hence pneumoperitoneum, there were no significant variations in minor complications and without major ones.