Is Pneumoperitoneum Really Required before Primary Trocar Insertion in Laparoscopy?

ABSTRACT Objectives Traditionally a Veress needle is used to create a pneumoperitoneum before entering the primary trocar/cannula for laparoscopy. Insufflation of gas into the peritoneal cavity with the Veress needle is not without its problems. To do away with these problems the technique of direct trocar access was started. Materials and methods Between 01 Jan 2003 and 31 Dec 2008— 2958 laparoscopic procedures were carried out in a Government hospital. 345 patients out of these had undergone previous laparotomies. In all cases direct trocar insertion without pneumoperitoneum was done. Result In this series there were no complications except in one case there was mesenteric injury with bleeding which required a laparotomy. There were no failed laparoscopies. Conclusion We have found that direct trocar insertion before creating pneumoperitoneum is a safe and effective method for laparoscopic access and offers advantages over the conventional access modality of using a Veress needle for pneumoperitoneum.