Direct trocar versus veress needle entry for laparoscopy: a randomized clinical trial.
OBJECTIVE
To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure, volume of gas used, ease of performance, and frequency of complications.


METHODS
A randomized clinical trial.


METHODS
One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either DT entry (group A, n = 500) or VN (group B, n = 500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon.


RESULTS
The duration of the procedure, volume of gas consumption, ease of performance and frequency of complications were analyzed.


RESULTS
Patients in the 2 groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group A (2.2 +/- 0.7 min, 95% CI 2.14-2.26) than in group B (8.2 +/- 1.4 min, 95% CI 8.08-8.32; p < 0.0001). The mean gas consumption was significantly less in group A (2.6 +/- 0.9 liters, 95% CI 2.52-2.68) than in group B (8.4 +/- 2.6 liters, 95% CI 8.17-8.63; p < 0.0001). No major complications in both groups were encountered. Minor complications were significantly less in group A (0.4%, 95% CI 0.77-3.23) than in group B (14%, 95% CI 10.96-17.04; p < 0.0001).


CONCLUSIONS
DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost and instrumentation and rapid creation of pneumoperitoneum.
Zakherah
Mahmoud S
MS
Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University, Assiut, Egypt.
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D009339:Needles; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments; D013997:Time Factors