COMPARISON OF OPERATIVE COMPLICATIONS OF DIRECT TROCAR ACCESS VERSUS VERESS NEEDLE INSERTION TECHNIQUE FOR INITIAL PERITONEAL ENTRY IN PATIENTS UNDERGOING GYNECOLOGICAL LAPAROSCOPIC SURGERY

Authors

  • Amna Rafiq Department of Gynecology PGMI/Ameerudin Medical College, Lahore-Pakistan
  • Al Fareed Zafar Principal & Prof of Gynecology PGMI/Ameerudin Medical College/Lahore General Hospital.
  • Maryam Javed Department of Gynecology PGMI/Ameerudin Medical College, Lahore-Pakistan
  • Mehwish Ilyas Department of Gynecology PGMI/Ameerudin Medical College, Lahore-Pakistan
  • Saima Saeed Usmani Department of Gynecology PGMI/Ameerudin Medical College, Lahore-Pakistan
  • Rizwana Tariq Department of Gynecology PGMI/Ameerudin Medical College, Lahore-Pakistan

Abstract

Background: Laparoscopy is considered to be a good diagnostic and surgical way to replace open surgeries in all surgical fields. As it is a least invasive method, with advantages for patients and all associated with medical care. There is a significant increase in the use of laparoscopic surgery in gynecology. This study was done to compare the frequency of operative complications of direct trocar access versus Veress needle insertion technique for initial peritoneal entry in patients undergoing gynecological laparoscopic surgery. Methods:  This Randomized Controlled Trial was conducted at the Department of Obstetrics & Gynecology, Lahore General Hospital, Lahore from 26-12-2019 to 25-6-2020. Four hundred consecutive patients were enrolled and divided randomly into two groups by blocked randomization. Direct trocar insertion (DTI) technique was used for initial peritoneal access in group A and Veress needle (VNI) was inserted first for peritoneal access in group B. Results: The mean age of the patients in DTI group was 35.76±8.38 years whereas that in VNI group was 35.85±8.38 years. In DTI group there were 8(4%) patients with extra-peritoneal insufflation and in VNI group there were 19(9.5%) patients with extra-peritoneal insufflation. There were 8(4%) patients in DTI group with Omental injury and VNI group there were 13(6.5%) patients with Omental injury. In DTI group there were 7(3.5%) patients with port-site infection compared to 15(7.5%) in VNI group. Conclusion: According to findings the rate of complications observed with VNI, DTI can be a preferred procedure for gynecological surgeries.

References

Pascual-Pedreño A, Perez-Medina T, Urkiaga IB, Fernández-Parra J, Sobreviela-Laserrada M. Practice of endoscopic gynecologic surgery: a survey of Spanish gynecologists. Eur J Obstet Gynecol Reprod Biol 2013;169(1):64-8.

Alkatout I. Complications of laparoscopy in connection with entry techniques. J Gynecol Surg 2017;33(3):81-91.

Fuller J, Ashar BS, Carey-Corrado J. Trocar-associated injuries and fatalities: an analysis of 1399 reports to the FDA. J Minim Invasive Gynecol 2005;12(4):302-7.

Brölmann H, Tanos V, Grimbizis G, Ind T, Philips K, van den Bosch T, et al. Options on fibroid morcellation: a literature review. Gynecol Surg 2015;12(1):3-15.

Ertugrul I, Kayaalp C, Yagci MA, Sumer F, Karagul S, Tolan K. Comparison of direct trocar entry and Veress needle entry in laparoscopic bariatric surgery: randomized controlled trial. J Laparoendosc Adv Surg Tech 2015;25(11):875-9.

Imran M, Chohan MZ, Mehmood Z, Mehmood K, Asif K. Comparison of Veress needle and direct trocar insertion in establishing pneumoperitoneum for laparoscopic cholecystectomy. Pak J Med Health Sci 2014;8:652-4.

Shayani-Nasab H, Amir-Zargar MA, Mousavi-Bahar SH, Kashkouli AI, Ghorban-Poor M, Farimani M, et al. Complications of entry using direct trocar and/or veress needle compared with modified open approach entry in laparoscopy: six-year experience. Urol J 2013;10(2):861-5.

Angioli R, Terranova C, Nardone CDC, Cafà EV, Damiani P, Portuesi R, et al. A comparison of three different entry techniques in gynecological laparoscopic surgery: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol 2013;171(2):339-42.

Byron JW, Fujiyoshi CA, Miyazawa K. Evaluation of the direct trocar insertion technique at laparoscopy. Obstet Gynecol 1989;74(3 Pt 1):423-5.

Tinelli A, Malvasi A, Guido M, Istre O, Keckstein J, Mettler L. Initial laparoscopic access in postmenopausal women: a preliminary prospective study. Menopause 2009;16(5):966-70.

Ahmad G, Baker J, Finnerty J, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev 2019(1):CD006583.

Borgatta L, Gruss L, Barad D, Kaali S. Direct trocar insertion vs. Verres needle use for laparoscopic sterilization. J Reprod Med 1990;35(9):891-4.

Kassir R, Blanc P, Lointier P, Tiffet O, Berger JL, Amor IB, et al. Laparoscopic entry techniques in obese patient: veress needle, direct trocar insertion or open entry technique? Obes Surg 2014;24(12):2193-4.

Günenç MZ, Yesildaglar N, Bingöl B, Önalan G, Tabak S, Gökmen B. The safety and efficacy of direct trocar insertion with elevation of the rectus sheath instead of the skin for pneumoperitoneum. Surg Laparosc Endosc Percutan Tech 2005;15(2):80-1.

Zakherah MS. Direct trocar versus veress needle entry for laparoscopy: a randomized clinical trial. Gynecol Obstet Invest 2010;69(4):260-3.

Altun H, Banli O, Kavlakoglu B, Kücükkayikci B, Kelesoglu C, Erez N. Comparison between direct trocar and Veress needle insertion in laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2007;17(6):709-12.

Mintz M. Risks and prophylaxis in laparoscopy: a survey of 100,000 cases. J Reprod Med 1977;18(5):269-72.

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Published

2021-04-28

How to Cite

Amna Rafiq, Zafar, A. F., Maryam Javed, Mehwish Ilyas, Saima Saeed Usmani, & Rizwana Tariq. (2021). COMPARISON OF OPERATIVE COMPLICATIONS OF DIRECT TROCAR ACCESS VERSUS VERESS NEEDLE INSERTION TECHNIQUE FOR INITIAL PERITONEAL ENTRY IN PATIENTS UNDERGOING GYNECOLOGICAL LAPAROSCOPIC SURGERY. Journal of Ayub Medical College Abbottabad, 33(2), 311–314. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/8683

Issue

Vol. 33 No. 2 (2021): Journal of Ayub Medical College Abbottabad

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ORIGINAL ARTICLE

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