title: The safety of direct trocar versus Veress needle for laparoscopic entry: a meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  This study assessed the safety of direct trocar insertion (DTI) versus Veress needle followed by primary trocar insertion (VN).
  
  
  METHODS
  Ovid MEDLINE(®), Cochrane Library, Google Scholar, Scopus, and the reference lists of published articles were searched up to September 2011 to identify randomized clinical trials comparing DTI with VN. This meta-analysis was restricted to randomized studies comparing the safety of these two laparoscopic entry techniques.
  
  
  RESULTS
  Seven randomized studies consisting of 2940 women (VN, n=1525; DTI, n=1415) were identified. The data on the safety of two entry techniques were abstracted, integrated, and analyzed with the meta-analysis method and are presented as pooled relative risk (RR) with 95% confidence intervals (CI). There were 4 cases of a major complication in the VN group in contrast to none in the DTI group. Pooled results failed to show a statistically significant difference in the risk of major complications between the two groups. A significantly higher risk of minor complications was detected in the VN group (RR [95% CI]=10.78 [6.27-18.51]). Among minor complications, preperitoneal injuries (46.73 [11.55-189.10]) and omental injuries (4.51 [2.12-9.62]) were the two most common complications in the VN group. There were significantly increased risks of multiple insertions (more than two attempts) (2.99 [2.11-4.23]) and failed entry (2.21[1.07-4.56]) in the VN group.
  
  
  CONCLUSIONS
  This meta-analysis suggests that the commonly used VN entry technique carries a significantly increased risk of minor complications. In addition, the likelihood of multiple insertions and failed entry are significantly higher in the VN group.
authors.affiliation: Department of Obstetrics and Gynecology, The Reading Hospital and Medical Center, Reading, Pennsylvania 19612-6052, USA. jiangx@readinghospital.org
authors.forename: Xuezhi
authors.initials: X
authors.lastname: Jiang
authors.forename: Charmaine
authors.initials: C
authors.lastname: Anderson
authors.forename: Peter F
authors.initials: PF
authors.lastname: Schnatz
mesh_terms: D004869:Equipment Safety; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D009339:Needles / Q000009:adverse effects*; D010537:Peritoneum / Q000293:injuries; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013525:Surgical Instruments / Q000009:adverse effects*; D014950:Wounds, Penetrating / Q000209:etiology / Q000517:prevention & control