A comparison of three different entry techniques in gynecological laparoscopic surgery: a randomized prospective trial

Objective: Laparoscopic entry techniques vary and still remain debated. We conducted a randomized control trial to compare three entry techniques. Study design: Women aged 18-70 years, nominated for laparoscopic surgery at University of Rome Campus Bio-Medico, were randomized into three different groups: Veress needle (VER), Direct trocar insertion (DIR) and Open technique (OP). For each group, minor complications (extra-peritoneal insufflation, trocar site bleeding, omental injury and surgical site infection), failed entry and time of entry of the main trocar were evaluated. Major complications were also considered. Between-group comparisons were performed using chi-square test. Significance P value was <0.05. Results: A series of 595 consecutive procedures were included: 193 in the VER group, 187 in the DIR group and 215 in the OP group. Minor complications occurred in 36 cases: extraperitoneal insufflation (n = 6) in the VER group only, site bleeding (n = 2 in the VER group, n = 2 in the DIR group and n = 1 in the OP group), site infection (n = 5 in the VER and 11 = 6 in OP group), and omental injury (n = 6 in the VER group and n = 3 in the DIR group). Failed entry occurred in 4 cases of the VER group and 1 case of the DIR group. Mean time of entry was 212.4, 71.4 and 161.7 s for the VER, DIR and OP groups respectively. Among major complications, one bowel injury resulted following the Veress technique. Conclusions: In our series, DIR and OP entry presented a lower risk of minor complications compared with VER. In addition, time of entry was shorter in DIR than with OP entry. (C) 2013 Elsevier Ireland Ltd. All rights reserved.