The Hasson Versus Veress Trocar Wars: Determining the Safety Index of Laparoscopic Surgical Entry Techniques

Abstract

Background: Classically, there are two techniques for establishing pneumoperitoneum in laparoscopic and robotic surgeries: the closed Veress needle technique and Hasson's technique for open placement of laparoscopic ports. Most surgeons prefer the open Hasson technique, even though it is not the gold standard. Some surgeons still favour the Veress needle technique despite literature linking it to visceral and vascular damage.

Aims: This study aimed at determining the safety index of the two techniques of establishing pneumoperitoneum in laparoscopic and robotic surgeries by evaluating the risk of injuries associated with Veress and Hasson's techniques.

Materials and methods: This is a retrospective cohort study evaluating the incidence of primary port placement injuries (PPPI) using Hasson's open trocar technique and Veress needle technique in 200 laparoscopic and robotic cases (emergency vs. elective) over a three-month period (January to March 2024) at Newcross Hospital. The exclusion criteria were secondary port injuries. IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York) and Microsoft Excel (Microsoft Corporation, Redmond, Washington) were used for data analysis.

Results: Hasson's open technique of primary port placement was used in 74% of emergency cases, while the Veress needle technique was used in 26% of emergency surgeries. Similarly, the most common technique for establishing pneumoperitoneum employed in elective surgical procedures was Hasson's open technique (77%). When comparing the safety index of the two techniques for establishing pneumoperitoneum, we found that there were no major PPPI associated with either technique, with minimal incidence of minor PPPI associated with both techniques. While some cases did involve injuries from secondary port insertions (bowel and vascular injuries), these were excluded according to our exclusion criteria. Additionally, no perioperative mortality associated with primary trocar placement was observed.

Conclusion: Although the literature describes the association of the Veress technique with visceral and vascular injuries, our study found it to be as safe as Hasson's open port placement technique. Therefore, either technique can be employed for the safe establishment of pneumoperitoneum in laparoscopic and robotic surgeries.

Keywords: hasson's technique; laparoscopic surgery; primary port placement injuries; safety index; veress needle.

Figure 1. Veress needle.

Attribution: Lx Zander via Wikimedia. This image is published under a Creative Commons license (CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=4481680).

Figure 2. Technique for Veress needle insertion. Panel A shows the appropriate infraumbilical site of incision for the Veress needle. Panel B shows how the Veress needle is inserted safely through the incision site.

Attribution: Alam et al. [20]. Permission was granted by Fahreyar Alam, the first author of the article. This image is published under the Creative Commons License.

Figure 3. Hasson's technique. Panel A shows the rectus sheath through a small supraumbilical incision. Panel B represents the dissection of the rectus sheath. Panel C displays the insertion of a Hasson’s port.

Attribution: Radhakrishna et al. [21]. Permission was granted by Veerabhadra Radhakrishna, the second author of the article. This image is published under a Creative Commons license.

Figure 4. Disposable trocars used in Hasson's port placement technique.

Attribution: Magnus1313 at English Wikipedia. This image is published under a Creative Commons license (CC BY-SA 3.0, https://commons.wikimedia.org/wiki/File:Disposable_Trocars.jpg).