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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9118.17

Abstract

Background: In laparoscopic surgery, establishment of pneumoperitoneum is the important step for the continuation of surgery. There are several techniques for the creation of pneumoperitoneum Veress needle, hasson’s cannula, direct trocar insertion and optical trocars. Aim: This is a prospective study for comparing the differences between the veress needle (VNI) and the direct trocar (DTI) insertion techniques, regarding the time, safety and complications.

Methods: In the department of general surgery, Govt. medical college, Omandurar govt. estate, Chennai, India, 306 cases of laparoscopic surgeries were operated from Nov 2016 to Dec 2017. Patient’s clinical data was recorded in a specially prepared proforma. The technique of pneumoperitoneum creation was alternately changed for every successive patient. Patients were followed up for immediate postoperative complications. The two groups were compared using appropriate statistical tests.

Results: Pneumoperitoneum was successfully created in all 306 cases. The mean access time was significantly lesser in the DTI (136.41 sec vs. 211.86 sec in VNI). Two cases of bowel injury that occurred in the DTI technique wasn’t statistically significant. Minor complications such as omental injury and extraperitoneal insufflation were significantly higher in the VNI. Multiple attempts were also needed for pneumoperitoneum creation in the VNI.

Conclusion: DTI is a safe, rapid and efficient alternative to VNI and other techniques of laparoscopic entry. And with expertise, it also has lower incidence rates of both major and minor laparoscopic entry complications.

 

 

Keywords : Laparoscopy; Pneumoperitoneum; Veress Needle Insertion Technique; Direct Trocar Insertion Technique. 

Corresponding Author : Sambandam Murugan, Raghunath, Assistant Professor, Department of General Surgery, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu 600002 India.