A comparative study between direct safety trocar insertion versus veress needle technique for creating pneumoperitoneum in laparoscopic surgeries


  • Ashirwad Datey Department Surgery, PCMS and RC, Bhopal, Madhya Pradesh, India
  • Satyendra Jain Department Surgery, PCMS and RC, Bhopal, Madhya Pradesh, India
  • Rahul Patel Department Surgery, PCMS and RC, Bhopal, Madhya Pradesh, India




Laparoscopic surgery, Pneumoperitoneum, Trocar insertion


Background: There are two methods of trocar insertion in laparoscopic surgeries one is direct insertion and second is Veress needle insertion. In this study we compared these two methods.

Methods: In this study we divided 50 patients equally into two group group A for in group A patients, direct trocar insertion technique was used for creation of pneumoperitoneum whereas amongst patients of group B, pneumoperitoneum was created using Veress needle insertion technique.

Results: The incidence of visceral injuries, vascular injuries and other post-operative complications were similar in both the groups. The present study observed no significant difference in failure rates between two methods.

Conclusions: Both the techniques i.e.; Direct trocar insertion (DTI) and Veress needle technique are equally effective, safe and feasible for creation of pneumoperitoneum during laparoscopic procedure.

Author Biography

Ashirwad Datey, Department Surgery, PCMS and RC, Bhopal, Madhya Pradesh, India

associate professor , department of surgery


Zhou MW, Gu XD, Xiang JB, Chen ZY. Comparison of clinical safety and outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Scientific World J. 2014;2014:274516.

Berci G, Cuschieri A, Chamberlain G, Partlow M. Practical laparoscopy. England: Bailliere Tindall; 1986: 44-65.

Mattingly RF, Linde RW, Thompson JD. Te Linde's operative gynecology. 11th ed. Philadelphia: Lippincott; 1985: 415-417.

Wheeless CR. Atlas of Pelvic Surgery. 2nd ed. Philadelphia: Lea and Febiger; 1988: 258-262.

Ahmad G, Gent D, Henderson D, Flynn H, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2015;8:6583.

Kumar S. Veress needle insertion through left lower intercostal space for creating pneumoperitoneum: Experience with 75 cases. J Minim Access Surg. 2012;8(3):85-9.

Theodoropoulou K, Lethaby DR, Bradpiece HA, Lo TL, Parihar A. Direct trocar insertion technique: an alternative for creation of pneumoperitoneum. JSLS. 2008;12(2):156-8.

Hashizume M, Sugimachi K. Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc. 1997;11(12):1198-201.

Vilos GA. Laparoscopic bowel injuries: forty litigated gynaecological cases in Canada. J Obstet Gynaecol Can. 2002;24(3):224-30.

Jansen FW, Kolkman W, Bakkum EA, Kroon CD, Kemper TC, Trimbos JB. Complications of laparoscopy: an inquiry about closed- versus open-entry technique. Am J Obstet Gynecol. 2004;190(3):634-8.

Mushtaq U, Naikoo GM, Gilkar IA, Ahmad PJ, Dar AW, Wani YH. Classical closed technique by veress needle insertion versus direct trocar insertion in the creation of pneumoperitoneum in various laparoscopic surgeries. Int J Contemp Med Res. 2019;6(7):9-13.

López C, Cid JA, Poves I, Bettónica C, Villegas L, Memon MA. Laparoscopic surgery in the elderly patient. Surg Endosc. 2003;17(2):333-7.

Briët JM, Mourits MJ, Leeuwen BL, Heuvel ER, Kenkhuis MJ, Arts HJ, et al. Age should not be a limiting factor in laparoscopic surgery: a prospective multicenter cohort study on quality of life after laparoscopic hysterectomy. Clin Interv Aging. 2018;13:2517-26.

Abdullah AA, Abdulmageed MU, Katoof FM. The efficacy of direct trocar versus veress needle method as a primary access technique in laparoscopic cholecystectomy. Mustansiriya Med J. 2019;18:47-50.

Ganesh MK, Dsouza RCC, Rao SN. Laparoscopic Port Entry methods - A Critical Review. IJSS J Surg. 2018;4(1):23-9.

Chauhan S, Masood S, Pandey A. Preoperative predictors of conversion in elective laparoscopic cholecystectomy. Saudi Surg J. 2019;7:14-9.

Sreejith V, Lohe Y, Tripathi V, Ansari A, Marak AB, Moirangthem GS. Direct trocar access: a safe method to create pneumo peritoneum, experience from GI and minimal access surgery unit, RIMS, Imphal. Int Surg J. 2019;6(4):1078-83.

Shatta AF, Girbash EF. Direct Trocar Insertion without Previous Pneumoperitoneum in Laparoscopic Gynecological Surgery. Clin Surg. 2020;5:2765.

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.

Nordestgaard AG, Bodily KC, Osborne RW, Buttorff JD. Major vascular injuries during laparoscopic procedures. Am J Surg. 1995;169(5):543-5.

Chávez E, Chávez JL, Ojeda A, Prado R, Hernández B, Vásquez C. Direct trocar insertion without pneumoperitoneum and the Veress needle in laparoscopic cholecystectomy: a comparative study. Acta Chir Belg. 2006;106(5):541-4.

Ahmad A, Kaur A. Primary Access in Laparoscopic Entry Techniques: An Update. Pan Asian J Obs Gyn. 2018;1(2):84-8.

Godara R, Verma V, Anand A, Mehta A. Randomised study to compare direct trocar insertion and Veress needle technique for creation of pneumoperitoneum in laparoscopic surgery. Int J Surg Med. 2019;5(1):5-9.

Garrido M, Sánchez Z, Gutiérrez I, Torrejón R, Sánchez C, Velasco A, et al. Direct trocar insertion without previous pneumoperitoneum versus insertion after insufflation with Veress needle in laparoscopic gynecological surgery: a prospective cohort study. J Obstet Gynaecol. 2019;39(7):1000-5.

Sinha S, Malik S. Veress needle versus direct trocar entry for laparoscopy: a retrospective study. Int J Reprod Contracept Obstet Gynecol. 2019;8:127-30.






Original Research Articles