Direct trocar insertion vs. Veress needle technique in laparoscopic surgeries. A systematic review and meta-analysis

Aim: To compare the safety and efficacy between Veress needle insertion and direct trocar insertion in laparoscopic surgeries.Methods: Relevant clinical trials were retrieved from major databases; Web of Science, Cochrane CENTRAL, PubMed, and SCOPUS. The following outcomes were pooled for analysis: failed entry, extraperitoneal insufflation, vascular lesion, omental lesion and visceral lesion, site bleeding, reintervention, subcutaneous emphysema, solid organ lesion, and infection of the trocar site. A fixed-effects model was used to analyze homogeneous outcomes, whereas random-effects models were used to analyze heterogeneous outcomes. Results: We included a total of twelve clinical trials. The pooled analysis showed that the Veress needle was accompanied by a significant increase in the incidences of extraperitoneal insufflation (RR = 0.204; 95% Cl [0.136, 0.307], P = 0.001), omental lesion (RR = 0.444 95% Cl [0.239, 0.825], P = 0.01), and failed entry (RR = 0.169 95% Cl [0.101, 0.284], P = 0.001). There is no significant difference between both cohort regarding the vascular lesion (RR = 0.847 95% Cl [0.259, 2.777), P = 0.7), infection of the trocar site (RR = 0.583 95%Cl [0.106, 3.216], P = 0.5, and visceral lesion (RR = 1.308 95% Cl [0.314, 5.438], P = 0.7. Conclusion: The DTI was accompanied by a significantly lower incidence of complications such as extraperitoneal insufflation, failed entry, omental lesion, and subcutaneous emphysema. On the other hand, both cohorts showed similar results regarding; vascular lesions, visceral lesions, reintervention, site bleeding, and solid organ lesion.(c) 2023 Elsevier Masson SAS. All rights reserved