A Modified Technique of Laparoscopic Closed-Entry by the Veress Needle: A Novel, Unique, Rapid, and Simple Procedure

Abstract

Background: Gynecologists usually perform the laparoscopic closed-entry technique to access the intraperitoneal cavity, while general surgeons prefer the open-entry approach, which takes more time. This study aims to introduce and discuss the novel modified closed laparoscopic entry technique. This method involves cutting the fascia after the skin incision to allow only the Veress needle to enter, thus avoiding complications arising from the closed procedure. This approach may benefit safe and quick laparoscopic entry, especially for obese patients.

Method of Technique: The current approach, which we call the modified closed Veress technique (MCVT), is a modification of the previously defined Veress needle entrance method. After the skin is cut, the subcutaneous fat tissue is released with the Mosquito clamp, the muscular fascia is held and hung with the Kocher clamp, and the incision is created large enough to insert the Veress needle. Then, the Veress needle is passed through the parietal peritoneum, the final step before reaching the intraperitoneal cavity.

Results: In our Gynecology and Obstetrics clinic, the current technique for the first entrance to the intraperitoneal cavity was used in a total of 294 patients between the years 2019-2023. There were no intraoperative or postoperative complications associated with the current approach. Moreover, in 12 patients who failed with the standard closed technique, intraperitoneal gas charging was provided in the first trial with the MCVT.

Conclusion: Because it is possibly as safe as the open technique and as quick as the standard closed technique, the MCVT may be one of the alternative techniques for the first laparoscopic entry into the peritoneal cavity to prevent complications and save time. Nevertheless, more thorough and patient-based prospective randomized research is required on this topic.