Abstract
Introduction Laparoscopy today is a common procedure in many surgical specialities, majority of complications arising from laparoscopy are often related to initial entry into the abdomen. Access related major complications include injury to viscera and vasculature while minor complications also occur such as postoperative wound infection, subcutaneous emphysema, and extraperitoneal insufflation. There is no clear consensus as to the optimal method of laparoscopic entry into the peritoneal cavity.
Objectives We aimed to compare safety and efficacy of Direct trocar insertion versus Veress needle technique in laparoscopic surgery.
Material and methods This prospective study was conducted on hundered patients who underwent laparoscopic surgery in our surgical unit at University of health Sciences from Jan 2015 to Oct 2016. Cases were randomly divided by sealed envelope method into two groups- 50 cases of direct trocar insertion and 50 cases of veress needle technique. Intraoperative access related parameters were recorded and compared. Data were analyzed with Student’s t and chi-squared tests. P value of <.05 was considered significant.
Result Both groups had comparable demographic profiles. Laparoscopic entry time (mean time taken in seconds to induce adequate pneumoperitoneum ) in direct trocar technique technique was 138±17.45 seconds whereas in Veress needle technique it was 209±25.88 seconds (p value = 0.00001). Periumblical bruise was observed in 2% cases of both groups, port site bleeding occurred in 4% cases of Veress needle group vs 2% in direct trocar group, omental laceration was observed in 4% cases of veress group vs none in other group. There was no other complication noted in either group.
Conclusions With a lower complication rate, direct insertion of trocar is a rapid and safe alternative to Veress needle insertion technique for the creation of pneumoperitoneum with additional benefit of less instrumentation/cost.

Key words: Laparoscopy, Pneumoperitoneum, Direct trocar insertion, Veress needle