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Home > Archives > Volume 20, No 8 (2022) > Article

DOI: 10.14704/nq.2022.20.8.NQ44558

Verres needle versus modified open technique as first access port in laparoscopy



Introduction: Accessing the abdominal cavity to create pneumo-peritoneum for laparoscopy is the first and the most crucial step. The entry related complications rate is accounting for about 50% of total complications of laparoscopic surgeries. Both of the most popular closed Veress needle and open Hasson’s cannula techniques are associated with complications Hasson requires a set of special instruments, and they must be fixed after the umbilicus is cut open, which proves to be time consuming. But the modified open technique diminishes the resistance of penetration, thus ensuring more safety and simplifying the laparoscopic entry process. It is fast, easy to learn with very few associated problems. Aim: Tocompare the Verres needle and modified open technique as first port in laparoscopy and check the feasibility of training the junior residents with one of the techniques. Material and methods: All the patients attending the departments of Obstetrics &Gynaecology, Surgical Gastroenterology and General Surgery of NRI MC & GH, requiring laparoscopy are selected into the study over a period of one year and were randomized to both procedures, the Veress needle and modified open technique. Patients contraindicated for general anaesthesiawere excluded.The descriptive data of the study subjects is noted and unpaired student’s “t” test is employed for analysis of collected data. Results:It is a cross-sectional, randomized, double blinded, observational study with 268 study subjects. There were 199 patients in group A who underwent laparoscopy by Modified Hasson technique. The Veress technique was used in 69 patients who belonged to group B. The entry access time (the time to place the first port) for group A was significantly lesser than that of group B (5.05 min vs. 17.3 min). There were a total of three complications in group B only. There was no significant difference between the two groups in terms of extraperitoneal port placement, intraperitoneal injury, failure to enter the abdomen, port site seroma, port site infection and mortality.Port site bleeding occurred in two cases in which one needed exploration. One bowel injury occurred in post laparotomy patient with modified open technique which is immediately repaired. Two mesenteric injuries occurred in Veress needle entry. Conclusion:A high cost and less availability of laparoscopic equipment is a challenge in developing countries. Establishing pneumoperitoneum through commonly described techniques not always be feasible. So the Modified open technique has an advantage of ease of access, safety, less time consuming and easy trainability to residents.


Accessing the abdominal cavity to create pneumo-peritoneum for laparoscopy

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