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

Purpose: We retrospectively compared the safety, efficacy, and relative ind ications of the Optiview visualizing trocar and the Veress needle for obtai ning transperitoneal laparoscopic access. Patients and Methods: Of 100 consecutive transperitoneal laparoscopic proce dures performed by a single surgeon, the Veress needle was used initially i n 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 fail ed. Patient characteristics (age, body mass index: [BMI], American Society of Anesthesiologists [ASA] score, and history of abdominal surgery), succes s rates, and complications were compared. Results: Access was obtained successfully with the Optiview in 25 of 26 cas es (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 needl e failures and the single Optiview failure. Age, BMI, ASA score, and histor y of abdominal surgery were not associated with access failure. There were no Optiview-related complications. Use of the Hasson cannula was not associ ated 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 co mplications (all minor): one colon insufflation, two retroperitoneal hemato mas, and one liver laceration. Conclusions: As an alternative to the Hasson cannula, the Optiview visualiz ing trocar is a safe and highly effective method of obtaining transperitone al laparoscopic access, particularly in those patients in whom difficulty i s encountered with the Veress needle. However, the needle is less expensive and, in our experience, has not been associated with significant complicat ions. Because we were unable to determine objective patient characteristics that increase the risk for Veress needle failure, we continue to use it fo r the first attempts at transperitoneal access in most patients.