Direct trocar insertion without the pneumoperitoneum in laparoscopic surgery - Is this a safe technique?

Introduction The classical closed method using the Veress needle and the open trocar placement technique with the Hasson cannula are commonly used to establish the pneumoperitoneum required for laparoscopic procedures. A less described and practiced technique is direct trocar insertion [DTI]. Those who are unfamiliar with DTI as an alternative procedure may be under the impression that it is hazardous. Method In this retrospective study, we analyzed DTI for peritoneal access and primary port placement in the first 100 consecutive cases of laparoscopic surgery and compared it against the first 100 cases using the Veress needle (VN) technique. Injuries were classed as major or minor depending on whether or not they significantly affected the performance of the procedure and the eventual outcome. Results Neither group suffered mortality or any major injuries. Minor injuries were infrequent. Peritoneal access and creation of laparoscopic workspace were attained faster and more efficiently by the direct trocar insertion technique. In the DTI group, the average time taken to establish pneumoperitoneum was one minute (42sec-3min04sec) while in the VN group it was 3.8minutes (2min40sec-8min10sec) which was significant (p