Introduction: Laparoscopy has revolutionised Surgery with its widespread acceptance as predominantly minimally invasive to intraabdominal surgical procedures. Creation of pneumoperitoneum is indispensable primary step of the procedure as it allows creation of operative field. It can be achieved by various techniques viz Classical open method as described by Hasson. The aim of the study was to ascertain safety of direct trocar insertion in creation of pneumoperitoneum in laparoscopic surgeries and adopt the same as an alternative to veress technique. Material and methods: A total of 576 patients were included in the study, Group A comprised of patients in whom we created pneumoperitoneum by classical veress needle insertion and included 327 patients. Group B comprised of 249 patients in whom we created pneumoperitoneum by direct trocar insertion method. Results: The mean age of patients was 47.54 years SD 11 with a male female ratio of 1:1.56. Laparoscopic cholecystectomy (52.08%) was most frequent followed by laparoscopic appendectomy (13.02%). Group A patients witnessed omental emphysema (7.95%) as commonest complication followed by preperitoneal insufflation(5.19%) while as the most common complication in group B was omental emphysema (0.81%). Port site infection (4.28%) and subcutaneous emphysema (3.36%) predominated in group A and port site infection (1.2%) and seroma formation (1.2%) were common in group B. Conclusion: There are many methods to create pneumoperitoneum. The closed technique modified to direct trocar insertion versus classical method by Veress were compared in patients undergoing laparocopic procedures at SMHS hospital for a period of one and a half year. The results are fascinating as the modified technique overshadows its classical version in terms of feasibility, efficacy and consumption of time.
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