Page 28 - World Journal of Laparoscopic Surgery

Comparative Study of Veress Needle and Visiport in Creating Pneumoperitoneum in Laparoscopic Surgery
Data Analysis morbidity and mortality with most common complications being
Data obtained from the proforma were entered in the Excel format; visceral and vascular injuries. Over the last three decades, rapid
the data presented in appropriate charts, tables, graphs, and figures. advances have made laparoscopic surgery a well-established entity.
However, laparoscopy being relatively new, there are controversies
Statistical Procedure regarding the best method of creating pneumoperitoneum. 5
Analysis in which qualitative variables were expressed as mean, To establish pneumoperitoneum, access to the peritoneal cavity
standard deviation, and median. Quantitative variables were can be gained through different ways that include Veress/trocar
expressed as proportion. Comparison quantitative data between (blind technique), the open technique (Hassons method), direct
two groups were analyzed by the independent samples t test. trocar insertion, disposable shielded trocars, radially expanding
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Comparison of qualitative variables between two groups was trocars, and the visual entry system. Related to this present
analyzed by the Chi-square test, association A. p value <0.05 was study, we have reviewed and compared 37 similar studies related
considered statistically significant. Data analysis was performed to different access techniques in creating pneumoperitoneum in
using SPSS version 22.0. various laparoscopic surgeries.
Laparoscopic surgery will only continue to expand in terms

observAtIon And results of procedures, which can be performed using technology.
The average age of the subjects in the Veress needle group was 33.1 Regardless of the procedure, the first step being induction of
± 12.8 years and that of the Visiport group was 35.4 ± 10.6 years. pneumoperitoneum; all surgeons need to achieve competence in
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Both group were comparable according to age. the technique.
36.0% of the Veress needle group and 60.7% of the Visiport In our study, 150 cases of Veress needle and 150 cases of Visiport
group were female. were compared and analyzed. This included appendicectomy,
100.0% of the Veress needle group and 98.7% of the Visiport cholecystectomy, laparoscopic inguinal and ventral hernia repair,
group have no vascular injury. laparoscopic sleeve gastrectomy, laparoscopic mini gastric bypass
98.0% of the Veress needle group and 99.3% of the Visiport and diagnostic laparoscopy, and laparoscopic closure of perforated
group have no visceral injury. duodenal ulcer.
96.7% of the Veress needle group and 100% of the Visiport In this study, there were two vascular injuries, both of them
group have no preparational insufflation. happened to the same surgeon who created pneumoperitoneum
0.7% of the Veress needle group and none of the Visiport group through the optiview trocar while attempting to do mini gastric
have failure of technique. bypass. Those two cases were converted to open and vascular
0.7% of the Veress needle group and 0.7% of the Visiport group surgeon was called in and repaired. This happened to the surgeon
have port site. who was inexperienced with the technique. The rest of all the
Average time required to induce pneumoperitoneum among Visiport cases were safe and faster in creating pneumoperitoneum
the Veress needle group was 3.1 ± 0.7 minutes and that of the during the surgery; there was no statistical significance on
Visiport group was 2.1 ± 0.4 minutes. The observed difference comparison of both the techniques. There were three omental
was statistically significant (p < 0.05). Time required to induce injuries with the Veress needle (2%). There was one omental
pneumoperitoneum among the Veress needle group was tear among the Visiport group (0.7%). There were five cases of
significantly greater than the Visiport group. preperitoneal insufflation among the Veress group (3.3%); no
Average duration of hospital stay among the Veress needle preperitoneal insufflation was noted in the Visiport group. There
group was 83.5 ± 36.1 hours and that of the Visiport group was was one failure of technique in the Veress group (0.7%). No failure
62.8 ± 34.3 hours. The observed difference was statistically of technique was noted in the Visiport group. There was one port
significant (p < 0.05). Duration of hospital stay among the Veress site hematoma in the Veress needle group (0.07%) and four cases
needle group was significantly greater than the Visiport group. of port site hematoma in the Visiport group (2.7%).
Average duration of surgery among the Veress needle group Time required to induce pneumoperitoneum using Veress
was 56.7 ± 17.2 minutes and that of the Visiport group was 59.6 ± needle was 3.1 ± 0.7 minutes and that of Visiport was 2.1 ± 0.4 minutes.
26.0 minutes. The observed difference was not statistically p value is 0.001. The observed difference was statistically significant.
significant (p > 0.05). Duration of surgery among the Veress needle Time required to induce pneumoperitoneum among the Veress
group was significantly greater than the Visiport group. needle group was significantly greater than the Visiport group.
Duration of surgery: average duration of surgery among
dIscussIon Veress needle was 56 ± 17.2 minutes and that of Visiport was 60 ±
25.6 minutes. Observed difference was not statistically significant
Ever since the first laparoscopy performed by Jacobeus of Sweden (p > 0.05).
in 1925, different techniques, technologists, and evidence-based Duration of surgery among Veress needle was significantly
guidelines have been introduced to eliminate the risk associated greater than Visiport.
with laparoscopic entry, whatever be the method adopted for first In the 5-year study of Lapham et al. from 2001 to 2006 using
port entry into the abdomen. 4 Visiport, 1,623 out of 1,626 cases were successful in inducing
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From studies, it has been proved that in 50% of laparoscopic pneumoperitoneum. There were three (0.2%) retroperitoneal
surgeries, major complications occur prior to the commencement vascular injuries. In the study of Dunne et al., there was visceral
of surgery and a delay in diagnosis of visceral injury will lead to injury with the Veress needle (0.1%) but there was no vascular injury
increased morbidity and mortality. 4 with the Veress needle technique. 7
Regardless of the methods used, gaining access to the In Struge et al.’s 4-year study, there were only (0.3%)
abdomen and initiating pneumoperitoneum remains a source of complications with Visiport in creating pneumoperitoneum.

74 World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019)