Direct trocar insertion vs. Veress needle technique in laparoscopic surgeries. A systematic review and meta-analysis

A A Elnaggar; K R Diab; B A El-Hangour; I Shawky Kamel; A M Farhat; A T Abdelsattar; M S Zarad

doi:10.1016/j.jviscsurg.2023.02.001

Direct trocar insertion vs. Veress needle technique in laparoscopic surgeries. A systematic review and meta-analysis

J Visc Surg. 2023 Oct;160(5):337-345. doi: 10.1016/j.jviscsurg.2023.02.001. Epub 2023 Feb 24.

Authors

A A Elnaggar¹, K R Diab¹, B A El-Hangour², I Shawky Kamel³, A M Farhat⁴, A T Abdelsattar³, M S Zarad²

Affiliations

¹ Department of General Sugery, Faculty of medicine, Fayoum University, Fayuom, Egypt.
² Department of General Sugery, Faculty of medicine, Al-Azhar University, Cairo, Egypt.
³ Faculty of Medicine, Fayoum University, Fayoum, Egypt.
⁴ Faculty of Medicine, Fayoum University, Fayoum, Egypt. Electronic address: am3760@fayoum.edu.eg.

PMID: 36842955
DOI: 10.1016/j.jviscsurg.2023.02.001

Abstract

Aim: To compare the safety and efficacy between Veress needle insertion and direct trocar insertion in laparoscopic surgeries.

Methods: Relevant clinical trials were retrieved from major databases; Web of Science, Cochrane CENTRAL, PubMed, and SCOPUS. The following outcomes were pooled for analysis: failed entry, extraperitoneal insufflation, vascular lesion, omental lesion and visceral lesion, site bleeding, reintervention, subcutaneous emphysema, solid organ lesion, and infection of the trocar site. A fixed-effects model was used to analyze homogeneous outcomes, whereas random-effects models were used to analyze heterogeneous outcomes.

Results: We included a total of twelve clinical trials. The pooled analysis showed that the Veress needle was accompanied by a significant increase in the incidences of extraperitoneal insufflation (RR = 0.204; 95% Cl [0.136, 0.307], P=0.001), omental lesion (RR=0.444 95% Cl [0.239, 0.825], P=0.01), and failed entry (RR=0.169 95% Cl [0.101, 0.284], P=0.001). There is no significant difference between both cohort regarding the vascular lesion (RR=0.847 95% Cl [0.259, 2.777), P=0.7), infection of the trocar site (RR=0.583 95%Cl [0.106, 3.216], P=0.5, and visceral lesion (RR=1.308 95% Cl [0.314, 5.438], P=0.7.

Conclusion: The DTI was accompanied by a significantly lower incidence of complications such as extraperitoneal insufflation, failed entry, omental lesion, and subcutaneous emphysema. On the other hand, both cohorts showed similar results regarding; vascular lesions, visceral lesions, reintervention, site bleeding, and solid organ lesion.

Keywords: Direct trocar; Laparoscope; Laparoscopic surgery; Veress needle.