Comparison of transperitoneal laparoscopic access techniques: Optiview visualizing trocar and Veress needle

Purpose: We retrospectively compared the safety, efficacy, and relative indications of the Optiview visualizing trocar and the Veress needle for obtaining transperitoneal laparoscopic access. Patients and Methods: Of 100 consecutive transperitoneal laparoscopic procedures performed by a single surgeon, the Veress needle was used initially in 96 patients, The Optiview was used on 26 occasions: in 4 patients as the initial access attempt, and in 22 patients after the Veress needle had failed. Patient characteristics (age, body mass index: [BMI], American Society of Anesthesiologists [ASA] score, and history of abdominal surgery), success rates, and complications were compared. Results: Access was obtained successfully with the Optiview in 25 of 26 cases (96%), whereas the Veress needle was successful in 72 of 96 (75%; P = 0.02), The Hasson cannula was used successfully after two of the Veress needle failures and the single Optiview failure. Age, BMI, ASA score, and history of abdominal surgery were not associated with access failure. There were no Optiview-related complications. Use of the Hasson cannula was not associated with any complications, but it was difficult to place, leaked gas, or both in two of the three patients. There were four Veress-related access complications (all minor): one colon insufflation, two retroperitoneal hematomas, and one liver laceration. Conclusions: As an alternative to the Hasson cannula, the Optiview visualizing trocar is a safe and highly effective method of obtaining transperitoneal laparoscopic access, particularly in those patients in whom difficulty is encountered with the Veress needle. However, the needle is less expensive and, in our experience, has not been associated with significant complications. Because we were unable to determine objective patient characteristics that increase the risk for Veress needle failure, we continue to use it for the first attempts at transperitoneal access in most patients.