The safety of direct trocar versus Veress needle for laparoscopic entry: a meta-analysis of randomized clinical trials

J Laparoendosc Adv Surg Tech A. 2012 May;22(4):362-70. doi: 10.1089/lap.2011.0432. Epub 2012 Mar 16.


Objective: This study assessed the safety of direct trocar insertion (DTI) versus Veress needle followed by primary trocar insertion (VN).

Methods: Ovid MEDLINE(®), Cochrane Library, Google Scholar, Scopus, and the reference lists of published articles were searched up to September 2011 to identify randomized clinical trials comparing DTI with VN. This meta-analysis was restricted to randomized studies comparing the safety of these two laparoscopic entry techniques.

Results: Seven randomized studies consisting of 2940 women (VN, n=1525; DTI, n=1415) were identified. The data on the safety of two entry techniques were abstracted, integrated, and analyzed with the meta-analysis method and are presented as pooled relative risk (RR) with 95% confidence intervals (CI). There were 4 cases of a major complication in the VN group in contrast to none in the DTI group. Pooled results failed to show a statistically significant difference in the risk of major complications between the two groups. A significantly higher risk of minor complications was detected in the VN group (RR [95% CI]=10.78 [6.27-18.51]). Among minor complications, preperitoneal injuries (46.73 [11.55-189.10]) and omental injuries (4.51 [2.12-9.62]) were the two most common complications in the VN group. There were significantly increased risks of multiple insertions (more than two attempts) (2.99 [2.11-4.23]) and failed entry (2.21[1.07-4.56]) in the VN group.

Conclusion: This meta-analysis suggests that the commonly used VN entry technique carries a significantly increased risk of minor complications. In addition, the likelihood of multiple insertions and failed entry are significantly higher in the VN group.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Equipment Safety
  • Female
  • Genital Diseases, Female / surgery*
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / instrumentation*
  • Needles / adverse effects*
  • Peritoneum / injuries
  • Pneumoperitoneum, Artificial / instrumentation
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Surgical Instruments / adverse effects*
  • Wounds, Penetrating / etiology
  • Wounds, Penetrating / prevention & control