Comparison of Direct Trocar versus Veress Needle Insertion in Creation of Pneumoperitoneum in Patients Undergoing Laparoscopic Cholecystectomy

Zafar Ali Choudhry; Muhammad Saleem Iqbal; Muhammad Latif; Kamran Hamid

doi:10.29054/apmc/2019.68

Zafar Ali Choudhry Vice Chancellor, Professor of Surgery Faisalabad Medical University, Faisalabad-Pakistan
Muhammad Saleem Iqbal Assistant Professor Surgery, Faisalabad Medical University, Faisalabad-Pakistan
Muhammad Latif Assistant Professor of Surgery Khawaja Muhammad Safdar Medical College, Sialkot-Pakistan
Kamran Hamid PGR, Surgery, Khawaja Muhammad Safdar Medical College, Sialkot-Pakistan

DOI: https://doi.org/10.29054/apmc/2019.68

Keywords: Laparoscopic cholecystectomy, Veress needle insertion, Direct trocar insertion, Pneumoperitoneum, Surgical Instrument, Laparoscopy

Abstract

Objective: Comparing outcome of Veress Needle (VN) versus Direct Trocar insertion (DTI) for creation of Pneumoperitoneum in laparoscopic Cholecystectomy. Study Design: Randomized Controlled Trial. Settings: Khawaja Muhamamd Safdar Medical College Surgical Department, Faisalabad Medical University Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot. Duration: 27-09-2017 to 26-09-2018. Methodology: A total number of 608 patients, having age 30 and 75 years planned for laparoscopic Cholecystectomy were selected. Detailed history, clinical examination & baseline investigations were carried out. Patients were divided into two groups. Group A (DTI), Group B (VN). All trocars and veress needle used were disposable, with a safety shield. Maximum 3 attempts were made and in case of failure open technique were used. The collected data was stored and analyzed in SPSS version 22. Chi-square test was used to compare no. of attempts between the groups. Results: Mean age of patients in present study was 47.99+11.01 years. There were 211 (34.70%) male patients and 297(65.30%) female patients. In DTI group, Pneumoperitoneum was created successfully in first attempt in 278 (91.4%) patients, in 2nd attempt in 20 (6.6%) patients and in 3rd attempt in 6 (2.0%) patients. While in VNI group Pneumoperitoneum was successful in first attempt in 256(84.2%) patient sin 2nd attempt in 38 (12.5%) patients and in 3rd attempt in 10 (3.3%) patients (p-value 0.02). Conclusion: Direct trocar is a safe alternative to veress needle insertion in laparoscopic cholecystectomy. It requires less number of attempts for successful creation of Pneumoperitoneum as compared to the veress needle.