A comparative study of open versus closed method of establishment of pneumoperitoneum in laparoscopic surgery


  • Adeesh P. Jain Department of Surgery, Baroda Medical College and SSG Hospital, Vadodara, Gujarat, India
  • Sarav C. Shah Department of Surgery, Baroda Medical College and SSG Hospital, Vadodara, Gujarat, India
  • Purva C. Shah Baroda Medical College and SSG Hospital, Vadodara, Gujarat, India
  • Karan R. Patel Department of Surgery, Baroda Medical College and SSG Hospital, Vadodara, Gujarat, India




Pneumoperitoneum, Veress needle, Hasson's method, Laparoscopy


Background: Laparoscopy has overtaken open surgery as the choice of procedure wherever feasible. More than 50% of complications in laparoscopy occur during creation of pneumoperitoneum. In this study, we are comparing open or Hasson's method and closed or vress method of creation of pneumoperitoneum.

Methods: This is a prospective comparative parallel randomised control trial conducted at the Department of Surgery, Baroda Medical College and SSG Hospital from November, 2017 to November, 2018. We divided the patients (n=100) into two groups i.e., open method (group O) (n1=50) and closed method (group C) (n2=50) groups using the envelope method of randomisation. We compared the two techniques in terms of time required to complete the procedures and complications (major and minor) associated with creation of pneumoperitoneum.

Results: All the patients that participated in this study belonged to the age group of 10-69 years out of which majority were 15-50 years old. In our study, the mean time required to create pneumoperitoneum by closed method (group C) was 9.3 seconds while by open method (group O), it was 7.84 seconds with p value <0.001. There were 15 cases of gas leak from the port side, all recorded in the open method of establishment of pneumoperitoneum.

Conclusions: Even though the open method takes less time to create pneumoperitoneum, both methods are similar in terms of time taken to complete the operation and major and minor complications because there was no statistically significant difference in the frequency of these parameters between the two techniques.


NHS Choices. NHS. Available at: https://www.nhs.uk/conditions/laparoscopy/#. t Accessed on 15 July 2019.

Agha R, Muir G. Does laparoscopic surgery spell the end of the open surgeon? Journal of the Royal Society of Medicine. J R Soc Med. 200;96(11):544–6.

Chotai NR, Choksi BB, Damor S, Bhedi A. Intraperitoneal access by closed method (veress needle) versus open (Hasson's) method in laparoscopic surgery to create pneumoperitoneum. Int Surg J. 2017;4(8):2786-90.

Perugini RA. Complications of laparoscopic surgery [Internet]. Surgical Treatment: Evidence-Based and Problem-Oriented. Holzheimer RG, Mannick JA, editors. Munich: Zuckschwerdt; 2001.

Kwak HD, Ju JK, Kang DW, Baek S-J, Kwak JM, Kim J, et al. Outcomes according to body mass index following laparoscopic surgery in patients with colorectal cancer [Internet]. J Min Access Surg. 2018;14:134-9.

Lécuru F, Leonard F, Philippe Jais J, Rizk E, Robin F, Taurelle R. Laparoscopy in patients with prior surgery: results of the blind approach Internet. JSLS. 2001;5(1):13–6.

Bathla V, Thekdi PI, Koradia P, Jhala D, Gadhvi U. Comparative study of modified open technique and closed technique for primary trocar insertion in laparoscopic surgery. Int J Res Med Sci. 2016;4(1):160–4.

Hamayun M, Saba N, Bilal M, Mehsud N. Comparison of open versus closed pneumoperitoneum in laparoscopic surgery. Gomal J Med Sci. 2015;13(2):115–7.

Taye MK, Fazal SA, Pegu D, Saikia D. Open Versus Closed Laparoscopy: Yet an Unresolved Controversy. J Clin Diagn Res. 2016;10(2):4-7.

Akbar M, Khan IA, Naveed D, Khattak I, Zafar A, Wazir MS, et al. Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy. J Ayub Med Coll Abbottabad. 2008;20(2):85-9.

Kumar R, Hastir A, Bandlish MK. Direct trocar insertion (DTI), Pneumoperitoneum, veress needle (VN), Laparoscopy. Pneumoperitoneum by direct trocar insertion: safe laparoscopic access. JEMDS. 2015;4 (15):2432-7.

Krishnakumar S, Tambe P. Entry complications in laparoscopic surgery. J Gynecol Endosc Surg. 2009;1(1):4–11.

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

Peitgen K, Nimtz K, Hellinger A, Walz MK. Open approach or Veress needle in laparoscopic interventions? Results of a prospective randomized controlled study. Chirurg. 1997;68(9):910-3.

Cogliandolo A, Manganaro T, Saitta FP, Micali B. Blind versus open approach to laparoscopic cholecystectomy: a randomized study. Surg Laparosc Endosc. 1998;8(5):353-5.

Nezhat C, Nezhat F, Silfen SL, Schaffer N, Evans D. Laparoscopic myomectomy. International journal of fertility. Int J Fertil. 1991;36:275–80.

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

Gullà N, Patriti A, Lazzarini F, Tristaino B. Our choice of the method to induce pneumoperitoneum in videolaparoscopic surgery. Minerva chirurgica. Minerva Chir. 2000;55(5):371-5.






Original Research Articles