Direct Trocar Insertion Reduces Pneumoperitoneum Creation Time but Does Not Shorten Overall Operative Duration

Open Access

Abstract

Background: Direct trocar insertion (DTI) is considered faster than Veress needle (VN) insertion for creating pneumoperitoneum, but it is uncertain whether time saved at entry shortens the total operation. Objective: To compare the time required to create pneumoperitoneum and the total operative duration between VN insertion and DTI in elective laparoscopic abdominal surgery. Methods & Materials: This prospective comparative study was carried out in the Department of General Surgery, Bangladesh Medical University, Dhaka, from August 2024 to July 2025. Thirty-eight patients undergoing elective laparoscopic surgery were purposively enrolled and divided equally into a VN group (n=19) and a DTI group (n=19). Pneumoperitoneum creation time was measured from the first incision to entry of the telescope and operative duration from the first incision to the last port-site closure. Data were analyzed in SPSS version 26 (p<0.05 considered significant). Results: The groups were comparable at baseline. The mean pneumoperitoneum creation time was significantly shorter with DTI than with the VN technique (2.69 ± 1.06 versus 6.29 ± 2.71 minutes; p<0.001) and the range was narrower (1.5-5.5 versus 1.0-15.0 minutes). Total operative duration was 54.63 ± 16.15 minutes in the DTI group and 57.63 ± 10.79 minutes in the VN group, a difference that was not significant (p=0.505). Conclusion: DTI shortened pneumoperitoneum creation by more than half, but this saving did not produce a statistically significant reduction in total operative duration. Time efficiency at entry alone should therefore not be the sole reason for choosing DTI.