Risks and benefits of two different entry techniques for laparoscopic gynecological surgeries

摘要

Background: Primary abdominal access still remains a challenge for laparoscopic surgery despite rapid advances. This study was conducted to prospectively analyse and compare risks and benefits of two different entry techniques namely, veress needle and direct trocar in laparoscopic gynaecological surgeries so as to obtain consensus on the optimal method to be followed to create pneumoperitoneum. Methods: This was a prospective randomized study conducted at Deen Dayal Upadhyay hospital, under Delhi government. During the period January 2014 to June 2016, 800 patients (20-65 years) operated laparoscopically by the same team of surgeons for various gynaecological conditions, were randomized in two groups: Veress needle group (VN) and Direct trocar group (DT). Each group comprised of 400 patients. Comparison of various parameters was done between the two groups. Results: Incidence of major complications in terms of visceral injuries was 0.75% (3/400) in DT group and nil in VN group. Open conversion rate (2/400 i. e. 0.5%) and number of attempts required to create pneumoperitoneum were also more in DT group. Failed access in previous surgery cases was 1.2% (1/38) in VN and 14.8% (4/27) in DT group. Incidence of port site bleeding (n=3) was also more in DT group. Although the incidence of minor complications such as extraperitoneal insufflations (n=5) and no. of failed access (n=6) were more in VN group, there was no incidence of any life-threatening complication. Conclusions: In our experience, there is clear evidence of advantage of using veress needle in preventing major complications. Veress needle is therefore safer, convenient and effective technique of creating pneumoperitoneum.