The efficacy and safety of different techniques for trocar insertion in laparoscopic surgery.

A review of the available published data reveals no discernable difference in the safety of the three commonly-used methods of trocar insertion (Veress needle, direct and open) for laparoscopic surgery. Each method has individual advantages and disadvantages, with similar morbidity and mortality, when performed by experienced operators with appropriate indications. The individual surgeon should assess which technique best suits his or her operating style in light of the particular circumstance of each patient. Preference should be given to the method with which the surgeon is most comfortable, or with which he or she has the most experience. All patients should be warned prior to undergoing abdominal surgery that, regardless of the method employed for laparoscopy, penetrating injury to internal structures occurs in approximately 1 in 1000 cases.