title: Comparison of Direct Trocar Entry and Veress Needle Entry in Laparoscopic Bariatric Surgery: Randomized Controlled Trial.
abstract: BACKGROUND
  We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VNI) techniques in laparoscopic bariatric surgery.
  
  
  METHODS
  Eighty-one patients scheduled for bariatric surgery at Inonu University, Malatya, Turkey, were included in this study. In 39 patients, a bladed retractable nonoptical trocar was used for DTI, and VNI was performed in 42 patients. Intraoperative access-related parameters were compared. Data were analyzed with Student's t and chi-squared tests. A P value of <.05 was considered significant.
  
  
  RESULTS
  Both groups had comparable demographic profiles. Laparoscopic entry time was shorter in the DTI group (79.6 ± 94.6 versus 217.6 ± 111.0 seconds; P < .0001). Successful entry rates in the first attempt, CO2 consumptions, failed attempt rates, and overall intraoperative complication rates were similar. However, in the DTI group, 2 patients had mesenteric injuries, and 1 of them required conversion to open surgery due to the mesenteric hemorrhage.
  
  
  CONCLUSIONS
  DTI in obese patients significantly shortens the entry time, but there can be severe complications with DTI when a nonoptical bladed trocar is used blindly. Actually, neither method can be recommended for entry into the abdomen in this population based on our results. If the surgeon has to choose a nonoptical trocar in bariatric surgery, preference for the VNI technique instead of the DTI technique is safer.
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey .
authors.forename: Ismail
authors.initials: I
authors.lastname: Ertugrul
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey .
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey .
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Yagci
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey .
authors.forename: Fatih
authors.initials: F
authors.lastname: Sumer
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey .
authors.forename: Servet
authors.initials: S
authors.lastname: Karagul
authors.affiliation: Department of Surgery, Inonu University , Malatya, Turkey .
authors.forename: Kerem
authors.initials: K
authors.lastname: Tolan
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D009339:Needles; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D013525:Surgical Instruments; D014421:Turkey / Q000453:epidemiology; D015431:Weight Loss