Meta-Analysis of Veress Needle Entry Versus Direct Trocar Entry in Gynecologic Surgery

Study Objective Although many studies have been performed, no consensus exists as to the ideal entry for laparoscopic gynecologic surgery. We sought out to compare the safety of direct trocar insertion with that of the Veress needle entry technique in gynecologic laparoscopic surgery. This is the largest analysis to date on this subject. Design Meta-Analysis. Setting Gynecologic laparoscopic surgery. Patients or Participants Randomized clinical trials comparing methods of laparoscopic initial entry. Interventions Inclusion criteria included women undergoing gynecological laparoscopic surgery, with the intervention of the direct trocar insertion technique compared with Veress needle entry technique. Measurements and Main Results The pooled analysis showed that Veress needle entry was associated with a significant increase in the incidences of extraperitoneal insufflation (RR=0.177, 95% Cl[0.094, 0.333], p<0.001), omental injury (RR=0.418, 95% Cl[0.195, 0.896], p<0.001), failed entry (RR=0.173, 95% Cl [0.102, 0.292], p<0.001), and trocar site infection (RR=0.404, 95% Cl[0.180, 0.909], p<0.029). There was no significant difference between the two groups regarding the visceral injury (RR=0.562, 95% Cl[0.047, 6.676], p<0.648). Conclusion When excluding all data apart from gynecologic surgery, the Veress needle entry technique may have an increased incidence of some, but not all complications of laparoscopic entry. It may also have a higher incidence of failed entry compared to direct entry techniques. Care should be taken in extrapolating these general results to specific surgeon experience levels. Although many studies have been performed, no consensus exists as to the ideal entry for laparoscopic gynecologic surgery. We sought out to compare the safety of direct trocar insertion with that of the Veress needle entry technique in gynecologic laparoscopic surgery. This is the largest analysis to date on this subject. Meta-Analysis. Gynecologic laparoscopic surgery. Randomized clinical trials comparing methods of laparoscopic initial entry. Inclusion criteria included women undergoing gynecological laparoscopic surgery, with the intervention of the direct trocar insertion technique compared with Veress needle entry technique. The pooled analysis showed that Veress needle entry was associated with a significant increase in the incidences of extraperitoneal insufflation (RR=0.177, 95% Cl[0.094, 0.333], p<0.001), omental injury (RR=0.418, 95% Cl[0.195, 0.896], p<0.001), failed entry (RR=0.173, 95% Cl [0.102, 0.292], p<0.001), and trocar site infection (RR=0.404, 95% Cl[0.180, 0.909], p<0.029). There was no significant difference between the two groups regarding the visceral injury (RR=0.562, 95% Cl[0.047, 6.676], p<0.648). When excluding all data apart from gynecologic surgery, the Veress needle entry technique may have an increased incidence of some, but not all complications of laparoscopic entry. It may also have a higher incidence of failed entry compared to direct entry techniques. Care should be taken in extrapolating these general results to specific surgeon experience levels.