Laparoscopic surgery has transformed surgical practiceoverthepastthreedecadesandisnowwidely accepted as the standard approach for numerous abdominal procedures. Comparedwithconventional open surgery, it offers significant advantages including reduced postoperative pain, shorter hospital stay, improved cosmetic results, and fasterreturntoroutineactivities(1,2).Thesebenefitshaveledto its widespread adoption across general surgery, gynecology, urology, and other specialties. Despite these advantages, laparoscopic surgery carries specific risks not encountered in open procedures. The most hazardous step is the initial entry into the abdominalcavityandthecreationof pneumoperitoneum. It is estimatedthatnearlyhalfofseriouslaparoscopiccomplicationsoccurduring this phase, particularly during insertion of theprimarytrocar(3,4).Reportedinjuriesincludevascular trauma, bowel perforation, omental injury, gas embolism, and subcutaneous emphysema. Although these complications are rare, they can be life-threatening and are responsible for most entry-related morbidity and mortality (5,6).

Several techniques have beendevelopedtoestablishpneumoperitoneumsafely.Theclosedtechnique, commonly performed using a Veress needle, involves blind insertion of a spring-loaded needle into the peritoneal cavity followed by carbon dioxide insufflation. It is widely used due to its simplicity, minimal incision size, and familiarity among surgeons (7). However, the blind nature of insertion raises concerns regarding unrecognized visceral or vascular injury (8).

The open technique, first described by Hasson, involves making a small infra-umbilical incision and entering the peritoneal cavity under direct vision before placing a blunt trocar (9). This method is believed to reduce the risk of major injuries by eliminating blind needle insertion. It is particularly recommended in patients with previous abdominal surgery, suspected adhesions, or obesity (10,11). However, critics argue that the open method may take longer, cause gas leakage, and require more surgical skill (12).

Numerousstudieshaveattemptedtocomparethesetwotechniques.Someauthorshavereportedlower rates of vascular and bowel injury with the open method (13,14), while others have found no significant difference in complication rates between the two approaches (15–17). Similarly,conflictingresultsexistregardingaccesstime.CertainstudiessuggestthattheVeressneedletechnique may be faster in experienced hands (18), whereas othersreportquickerentrywiththeopentechnique due to direct visualization (19,20).

Because of these conflicting findings, there is still no universal consensus on the ideal entrytechnique. The choice often depends on surgeon training, institutional practice, and patient characteristics. In high-volume tertiary care centres, identifying an entry methodthatisbothsafeand efficient is essential for optimizing operative outcomes and reducing surgical delays.

Local data comparing laparoscopic entry techniques remain limited. Therefore, this prospective comparative study was undertaken to evaluate the access time and safety of closed and open pneumoperitoneum techniques in a tertiary care teaching hospital. The study aims to contribute to existing evidence and help guide surgeons in selecting the most appropriate entry approach for laparoscopic procedures.

MATERIALSANDMETHODS

This prospective comparativestudywasconductedintheDepartmentofGeneralSurgeryata tertiary care teaching hospital after obtaining institutional ethical clearance and informed consent from all participants. The study included patients undergoing elective laparoscopic procedures during the study period. Patients aged 18–70 years scheduled for elective laparoscopic surgery were eligible for inclusion. Patients undergoing emergencysurgery,thosewithcontraindicationstopneumoperitoneum,andthose with severe cardiopulmonary instability were excluded. Participants were allocated into two groups based onthetechniqueusedtoestablishpneumoperitoneum.GroupAunderwenttheclosedtechnique using a Veress needle, while Group B underwent the open technique using the Hasson method.

All procedures were performed under general anesthesia using standard aseptic precautions. In the closed technique group, the Veress needle was inserted through an infra-umbilical incision, and correct placement was confirmedusingstandardsafetytestsbeforeinsufflation.Intheopentechnique group, a small infra-umbilical incisionwasmade,thefasciaandperitoneumwereopenedunderdirect vision, and a blunt trocar was inserted.

Theprimaryoutcomevariablewasaccesstime,definedastheintervalfromskinincisiontosuccessful placement of the primary trocar with established pneumoperitoneum. Secondary outcome variables includedintra-operativecomplicationssuchasbowelinjury,vascularinjury,gasleak,andfailedentry, as well as postoperative complications such as port-site infection and subcutaneous emphysema.

All observations were recorded using a standardized proforma. Postoperative follow-up was performed during hospital stay and at outpatient review. Data were entered into statistical software and analysed using appropriate tests. Continuous variables were expressed as mean ± standard deviation, and categorical variables as proportions. A p-value <0.05 was considered statistically significant.

RESULTS

Atotalofpatientsundergoingelectivelaparoscopicprocedureswereincludedinthestudyanddivided equally between the closed andopentechniquegroups.Thedemographiccharacteristicsofpatientsin both groups were comparable,withnosignificantdifferenceinagedistributionFigure1,genderratio Figure2,or type of laparoscopic procedure performed. This ensured that the two groups were suitable for comparison

The primary outcome analysed was accesstime.Thestudydemonstratedthatthemeanaccesstimein the closed technique group was 9.09 minutes, whereas the mean access time in the open technique group was 7.23 minutes Table 1 & Figure 3

Statistical analysis showed thatthisdifferencewassignificant,indicatingthatpneumoperitoneumwas established more rapidly using the open method in the presentstudy.Theshorterentrytimeobserved with the open technique may be attributed to direct visualization of tissue layers and elimination of confirmatory tests required for Veress needle placement.

With regard to intra-operative complications, no major vascular or visceral injuries were observedin either group Figure 4.

This indicates that both entry techniques were safe when performed by trained surgeons in acontrolled surgical setting. Minor complications were noted in a small proportion of cases in both groups. These included transientgasleakaroundthetrocarsite,difficultyininitialentry,andminimal subcutaneousemphysema.Theincidenceoftheseminorcomplicationswassimilarinbothgroupsand did not show statistical significance.

Postoperative outcomes were also comparable Figure 5 . No patient required conversion to open surgery due to entry-related complications. Port-site infections were rare and responded to conservative treatment. Duration of hospital stay did not differ significantly between thetwogroups, suggesting that entry technique did not influence postoperative recovery in a meaningful way

The duration of hospital stay was comparable between the two groups, with no statistically significant difference observed, indicating that the choice of entry technique did not influencepostoperativerecoveryorlengthofhospitalization(Figure 6).

Overall, the results of this study demonstrate that both closed and open techniques are safe for establishing pneumoperitoneum. However, the open technique showed a statistically significant advantage in terms of shorter access time.

DISCUSSION

The present study evaluated two widely practiced techniques for creation of pneumoperitoneum in laparoscopic surgery and found thatbothmethodsweresafe,withtheopentechniqueprovidingfaster access.

Our finding of shorter entrytimewiththeopentechniqueisconsistentwithreportsbyJamiletal.and Vilos et al., who observed that direct visualization allows quicker trocar placement and avoids repeated attempts required in blind needle insertion (19,20). Similar observations were made by Merlin et al., who concluded that the open approach reduces delays associated with incorrect Veress needle positioning (21).

However, other studies have suggested that the closed technique may be faster when performed by experienced surgeons (18,22). The variation in findings may be explained by differences in surgeon training, patient characteristics, and institutional protocols.

In terms of safety, our study showed no major visceral or vascular injuries in either group. This supports earlier studiesbyJansenetal.andChapronetal.,whichconcludedthatbothtechniqueshave comparable safety profiles when performed by trained surgeons (3,15). Hasson originally introduced the open technique specifically to reduce blind insertion injuries, and subsequent research has supported its use in patients with prior abdominal surgery or suspected adhesions (9,11,12-15).

Minor complications observed in the present study,includinggasleakandsubcutaneousemphysema, have also been reported in previous comparisons ofentrytechniques(15,16,23).Thesecomplications are usually self-limiting and rarely affect operative outcomes.

Several large observational studies and systematic reviews have shown that most serious complications in laparoscopy occur during abdominal entry, although the absolute incidenceremains low. Previous analyses report that vascularandbowelinjuriesarerarebutpotentiallylife-threatening, reinforcing the importance of safe pneumoperitoneum creation techniques (24,26,28). Comparative reviews of entry methods indicate that no single technique completely eliminates risk, and outcomes depend largely on surgical expertise and patient factors (25,29). Studies evaluating trocar andVeress needle injuries confirm that the majority of complications occur at the time of primary access rather than during the operative procedure itself (26,28).

Evidence from both international and Indian studies suggests that complication rates are generally comparable betweenopen,closed,anddirecttrocarinsertionmethods,withdifferencesmainlyseenin access time and technical ease rather than safety (27,31,32). Researchcomparingpneumoperitoneum techniques has also demonstrated that surgeon familiarity with the method plays a greater role in preventing complications than the choice of entry technique itself (29,31). In patients with previous abdominalsurgery,alternativeentrystrategiesandcarefultechniqueselectionarerecommendedto reduce the risk of adhesional injury (30-32). Taken together, these findings support the results of the present study, which also demonstrated comparable safety between techniques with differences primarily related to access efficiency.

Taken together, the available evidence suggests that no single entry techniqueisuniversallysuperior. Surgeon experience, patient anatomy, and operative context play a critical role in determining outcomes. Training programs should therefore ensure proficiency in both methods so that surgeons can tailor the approach to individual patients.

CONCLUSION

Both the closed (Veress needle) and open (Hasson) techniques for creationofpneumoperitoneumare safe and effective methods for laparoscopic entry. The present study demonstrated that the open technique provides a statistically shorter access time while maintaining a comparable safety profile. Selection of entrytechniqueshouldthereforebeindividualizedbasedonsurgeonexpertiseandpatient factors.

ACKNOWLEDGEMENT

The authors sincerely thank all patients who participated in this study for their cooperation and trust. We also acknowledge the support of the Department of General Surgery, operating theatre staff, nursing personnel, and hospital administration for theirassistancein conducting the study and facilitating data collection.

We express our gratitude to the institutional ethics committee for their guidance and approval, which ensured that the study was conducted in accordance with accepted ethical standards. We also thank our colleagues and faculty members who provided valuable suggestions during the planning and execution of the study.

Funding

This research received no external fundingandwasconductedusinginstitutionalresources. The authors declare that no financialsupportorsponsorshipinfluencedthedesign,conduct, analysis, or reporting of the study.

ConflictofInterest

Theauthorsdeclarethatthereisnoconflictofinterestrelatedtothisstudy.

Author Contributions

All authors contributed substantially to the conception, study design, data collection,analysis, manuscript preparation, and final approval of the version submitted for publication.

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