LAPAROSCOPIC CHOLECYSTECTOMY: DIRECT TROCAR INSERTION VERSUS VERESS NEEDLE TECHNIQUE FOR LAPAROSCOPIC ENTRY
Dr. Hassan Khalil Melek* MD
Background: In laparoscopic surgey, Laparoscopic Entry (LE) and establishment of pneumoperitoneum is very important step because 50% of visceral and vascular injuries occur during this step. There are several techniques for laparoscopic entry. The classical technique is use of Veress Needle (VN) which has many disadvantages such as slow insufflation rate, visceral and vascular injuries. Direct Trocar Insertion (DTI) technique without prior pneumoperitoneum is regarded as safe and fast procedure. Objectives: The aim of this study was to compare VN technique and DTI technique for LE and establishment of pneumoperitoneum regarding time and safety. Patients and Methods: This was a prospective study performed during period from May 2012 to April 2016. A total of 446 patients (395 females and 51 males) with symptomatic cholelithiasis underwent Laparoscopic Cholecystectomy (LC) were included in this study. VN was used in 210 patients and DTI was used in 236 patients. All operations were performed by single laparoscopic surgeon. The Mean±SD of patient's age was 39.6±12 years (range, 16 to 75). Results: The Mean±SD of time of DTI (1.9±0.9 minutes) was shorter than that of VN (5.37±1.6 minutes.), P-value =˂ 0.001. There were no major complications nor mortality in both techniques. There were no significant differences in the incidence rates of minor complications in both techniques except subcutaneous emphysemas which occurred more in VN technique. Conclusions: DTI technique for Laparoscopic entry is safer and faster alternative than VN technique.
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