Comparison of Complications between Direct Trocar Insertion Versus Veress Needle for Creation of Pneumoperitoneum in Patients Undergoing laparoscopic Cholecystectomy: A Randomized Control Trial
Kamran Hamid
Department of Surgery, Islam Medical College, Sialkot, Pakistan.
Shabbir Ahmad
Department of Surgery, Khawaja Muhammad Safdar Medical College, Pakistan.
Bahzad Akram Khan
West Surgical Unit, Mayo hospital/King Edward Medical University, Lahore, Pakistan.
Muhammad Faheem Answer
Department of Surgery, CMH Medical College, Lahore, Pakistan.
Amer Latif
Department of HPB Surgery, Shaikh Zayed Hospital, Lahore, Pakistan.
Syed Mazhar Ali Naqvi
Department of Pulmonary and Critical Care Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
Muhammad Afzal Bhatti
Department of Hepatology and Gastroenterology, Bahria International Hospital, Lahore, Pakistan.
Muhammad Asim Rana
Department of Internal and Critical Care Medicine, Bahria International Hospital Lahore, Pakistan.
Muhammad Mansoor Hafeez *
Department of Medicine, Expert Doctor Private Limited, Lahore, Pakistan.
*Author to whom correspondence should be addressed.
Abstract
Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy.
Design: Randomized controlled trial
Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020.
Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant.
Results: The complication rate in VNI group were significantly greater than the DTI group (p < 0.01), the duration of surgery between the two groups was not significantly different (p > 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p < 0.001).
Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.
Keywords: Laparoscopic cholecystectomy, veress needle insertion, direct trocar insertion, Pneumoperitoneum