Classical Closed Technique by Veress Needle Insertion Versus Direct Trocar Insertion in the Creation of Pneumoperitoneum in Various Laparoscopic Surgeries

Introduction: Laparoscopy has revolutionised Surgerywith its widespread acceptance as predominantly minimallyinvasive to intraabdominal surgical procedures. Creationof pneumoperitoneum is indispensable primary step ofthe procedure as it allows creation of operative field. Itcan be achieved by various techniques viz Classical openmethod as described by Hasson. The aim of the study wasto ascertain safety of direct trocar insertion in creation ofpneumoperitoneum in laparoscopic surgeries and adopt thesame as an alternative to veress technique.Material and methods: A total of 576 patients were includedin the study, Group A comprised of patients in whom wecreated pneumoperitoneum by classical veress needleinsertion and included 327 patients. Group B comprised of249 patients in whom we created pneumoperitoneum by directtrocar insertion method.Results: The mean age of patients was 47.54 years SD 11 witha male female ratio of 1:1.56. Laparoscopic cholecystectomy(52.08%) was most frequent followed by laparoscopicappendectomy (13.02%). Group A patients witnessed omentalemphysema (7.95%) as commonest complication followed bypreperitoneal insufflation(5.19%) while as the most commoncomplication in group B was omental emphysema (0.81%).Port site infection (4.28%) and subcutaneous emphysema(3.36%) predominated in group A and port site infection(1.2%) and seroma formation (1.2%) were common in groupB.Conclusion: There are many methods to createpneumoperitoneum. The closed technique modified to directtrocar insertion versus classical method by Veress werecompared in patients undergoing laparocopic proceduresat SMHS hospital for a period of one and a half year. Theresults are fascinating as the modified technique overshadowsits classical version in terms of feasibility, efficacy andconsumption of time.