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Laparoscopic surgery relies heavily on safe and efficient pneumoperitoneum establishment. Two primary techniques dominate this process: the Veress needle (closed technique) and the Hasson trocar (open technique). This article explores their pros, cons, and clinical applications to guide surgical decision-making.
1. Veress Needle: Technique and Advantages
The Veress needle, introduced in 1938, involves blind insertion of a spring-loaded needle into the abdominal cavity to insufflate CO₂.
Disposable Veress Needle | GCMEDICA
Advantages:
Minimally Invasive: Requires only a small puncture site, reducing postoperative pain.
Speed: Quick setup in uncomplicated cases, ideal for routine procedures.
Cost-Effective: Single-use or reusable options lower procedural expenses.
Limitations:
Blind Insertion Risks: Higher rates of vascular or visceral injury (0.05%–2.8%), especially in patients with prior abdominal surgery or low BMI.
Contraindications: Unsafe for suspected adhesions or pediatric populations due to proximity of major vessels.
2. Hasson Trocar: Technique and Advantages
The Hasson technique, developed in 1978, uses a blunt-tipped trocar inserted under direct vision via a small incision.
Advantages:
Safety: Visual entry minimizes injury risks, preferred for high-risk patients (e.g., obesity, adhesion history) .
Versatility: Allows simultaneous specimen extraction and reduces gas leakage with sutured fascial fixation .
Pediatric Use: Safer for children due to controlled entry.
Limitations:
Longer Setup: Requires incision dissection, though CO₂ insufflation speed matches Veress.
Larger Incision: Higher gas leakage potential without proper closure
3. Key Comparisons
| Factor | Veress Needle | Hasson Trocar |
| Safety | Higher complication risks | Lower complication risks |
| Patient Suitability | Uncomplicated cases | Prior surgery, adhesions, obesity |
| Learning Curve | Steeper (blind technique) | Easier (visual guidance) |
| Cost | Lower | Higher (additional instruments) |
4. Clinical Recommendations
Veress Needle: Optimal for low-risk, first-time surgeries with no adhesion concerns.
Hasson Trocar: Mandatory for complex cases, pediatric patients, or when adhesions are suspected.
Conclusion
Both techniques have distinct roles in laparoscopic surgery. While the Veress needle offers speed and minimal invasiveness, the Hasson trocar prioritizes safety in high-risk scenarios. Surgeons must weigh patient-specific factors to optimize outcomes.
Keywords: Veress needle vs Hasson trocar, laparoscopic surgery techniques, pneumoperitoneum methods, surgical safety comparison
