Veress needle versus direct trocar entry for laparoscopy: a retrospective study

Sushma Sinha, Surya Malik


Background: The aim of this paper is to compare the outcomes of veress needle entry versus direct trocar for laparoscopy in terms of the duration of the procedure, ease of performance and the complications encountered during each technique.

Methods: The present study was conducted on a retrospective basis from April ‘2008 to September 2017, in the dept of Obstetrics and Gynecology, in a 100 bedded hospital, ABGH hospital. All the cases who underwent laparoscopic ligation procedure during this time were taken into account. From 2008 to 2012 traditional technique of veress needle entry was used for access(group -1) but it had been switched over to direct trocar since 2013(group -2) These two groups were compared in terms of the demographic profile, duration of procedure, previous h/o surgical interventions ,ease of performance and various complications encountered during the procedure.

Results: The total number of patients who underwent ligation during this period were 1912, which were divided into two groups ,till 2012(veress needle entry group,group-1) 754 patients(39.44%),and after 2012 (direct trocar,group -2) 1158 patients(60.56%).Duration of procedure was 4.5±1.2 min in group 1 which was significantly higher than group 2,2.2±0.8 min(p-value <0.001).Amount of gas required was greater in group 1, 4.9±1.3 lts as compared to group 2,2.4±0.5lts.

Conclusions: Direct trocar entry is a reliable alternative to traditional technique for pneumoperitoneum establishment and should be regarded as a part of the surgical armamentarium of a trained laparoscopic surgeon.


Pneumoperitoneum, Surgical Interventions, Veress needle

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Jacobson MT et al. The Direct Trocar Technique : An Alternative Approach to Abdominal Entry for Laparoscopy. J Soc Laparoendos Surg. 2002;6(2):169-74.

Manufacturer and User Facility Device Experience Database (MAUDE) (database online). Rockville, MD: US Food and Drug Administration. Available at http://

Bhoyrul S, Vierra MA, Nezhat CR, Nezhat CH, Krummel TM, Way LW. Trocar injuries in laparoscopic surgery. J Am Coll Surg. 2001;192(6): 677-83.

Patel PG, Chikhalia DP, Patel R, Jadav S, Dave AM. Direct Trocar Entry in Laparoscopic Surgeries: A Retrospective Study. Gastroenterol Hepatol J. 2017;1(109):29-33.

Jansen FW, Kapiteyn K, Trimbos‐Kemper T, Hermans J, Trimbos J. Complications of laparoscopy: a prospective multicenter observational study. Br J Obstet Gynaecol. 1997;104(5):595-600.

Bateman BG, Kolp LA, Hoeger K. Complications of laparoscopy- operative and diagnostic. Fertil Steril. 1996;66(1):30-5.

Lehmann-Willenbrock E, Riedel HH, Mecke H, Semm K. Pelviscopy/laparoscopy and its complications in Germany 1949-1988. J Reprod Med. 1990;37(8):587-9.

Peterson HB, Hulka JF, Philips JM. American Association of Gynecologists and Laparoscopists 1988-member survey on operative laparoscopy . J Reprod Med.1990;35(6):587-9.

Harkki-Sirén P, Kurki T. A nationwide analysis of laproscopic complications. Obstet Gynecol. 1997;89(1):108-12.

Dingfelder JR. Direct laparoscopic trocar insertion without prior pneumoperitoneum . J Reprod Med. 1978;21(1):45-7.

Byron JW, Markensen G, Miyazawa K. A randomised comparison of Veress needle and trocar insertion for laparoscopy. Surg Gynecol Obstet. 1993;177(3):259-62.

Zakherah M.S. Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomised Clinical Trial.Gynecol Obstet Invest 2010;69(4):260-3.

Inan A, Sen M, Dener C, Bozer M. Comparison of direct trocar and Veress needle insertion in the performance of pneumoperitoneum in laparoscopic cholecystectomy . Acta Chir Belg. 2005;105(5):515-8.

Prieto-Díaz-Chávez E, Medina-Chávez JL, González-Ojeda A, Anaya-Prado R, Trujillo-Hernández B, Vásquez C. Direct trocar insertion without pneumoperitoneum and the Veress needle in laparoscopic cholecystectomy: a comparative study. Acta Chir Belg 2006;106(5):541-4.

Theodoropoulou K, Lethaby DR, Bradpiece HA, Lo TL, Parihar A. Direct trocar insertion technique: an alternative for creation of pneumoperitoneum. JSLS 2008;12(2):156-8.

Borgatta L, Gruss L, Barad D, Kaali SG: Direct trocar insertion vs Veress needle for laparoscopic sterilization. J Reprod Med 1990;35(9):891-4

Günenç MZ, Yesildaglar N, Bingöl B, Önalan G, Tabak S, Gökmen B. et al: The safety and efficacy of direct trocar insertion with elevation of the rectus sheath instead of the skin for pneumoperitoneum.Surg Laparosc Endosc Percutan Tech. 2005;15(2):80-1.