{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:20:33Z","timestamp":1787847633576,"version":"build-2784847793"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Initial intraperitoneal access and first trocar entry are responsible for nearly half of all complications of laparoscopic surgery. The purpose of this article is to detail our method of initial intraperitoneal access with Veress needle and first trocar at the umbilicus used over the past 28 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>Since 1990, a single surgeon performed laparoscopic surgery in 7600 patients. From 1992 onward, 6975 patients underwent laparoscopic surgery. On assessment, 739 cases (10.6%) were found unsuitable for Veress needle entry at the umbilicus. The remaining, 6236, patients form the study group for this article. Every patient was operated in the identical, repetitive manner. Every detail was considered important. The method of the first trocar entry is modified to minimise complications of this manoeuvre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The average time from cleaning umbilicus again to Veress needle tip in peritoneum was 1 min 40 s (25 s\u20137 min). Out of the 4228 patients in whom no adhesions were observed at first trocar entry (Group 1), the Veress needle insertion was successful at first attempt in 3829 (90.5%) patients, at second attempt in 322 (7.6%) and at third attempt in 30 (0.7%). In the 2008 patients with significant adhesions observed after first trocar entry (Group 2), successful insertion of the Veress needle was achieved at first attempt in 1700 (84.6%) patients, at second attempt in 182 (9%) and at third attempt in 19 (0.9%). In this group, there was one bowel injury (0.05%) and 3 (0.15%) minor vascular injuries. There was no mortality in either group. In the overall series, the Veress needle was successfully introduced in 6082 of the 6236 patients (97.5%) and 154 patients (2.4%) failed Veress needle entry. The incidence of bowel injury in the series was 0.016% and that of minor vascular injuries was 0.048%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Initial intraperitoneal access must be performed with utmost caution after adequate training and proctorship. This paper stresses with meticulous attention to every detail, this safe, method of initial intraperitoneal access leads to low complication rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmas.jmas_235_20","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T14:27:01Z","timestamp":1617978421000},"page":"329-336","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Method for safe Verres needle entry at the umbilicus, with modification for first trocar entry to reduce the complication rate of first entry"],"prefix":"10.4103","volume":"17","author":[{"given":"Tehemton Erach","family":"Udwadia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-9-20240828","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S1091-255X(00)80018-9","article-title":"A randomised prospective study of radially expanding trocars in laparoscopic surgery","volume":"4","author":"Bhoyrul","year":"2000","journal-title":"J Gastrointest Surg"},{"key":"R2-9-20240828","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1007\/s004640080056","article-title":"Use of the optical access trocar for safe and rapid entry in various laparoscopic procedures","volume":"15","author":"String","year":"2001","journal-title":"Surg Endosc"},{"key":"R3-9-20240828","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1046\/j.1365-2508.1999.00307.x","article-title":"Optical Veress as an entry technique","volume":"8","author":"McGurgan","year":"1999","journal-title":"Gynaecol Endosc"},{"key":"R4-9-20240828","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S1072-7515(01)00913-9","article-title":"Trocar injuries in laparoscopic surgery","volume":"192","author":"Bhoyrul","year":"2001","journal-title":"J Am Coll Surg"},{"key":"R5-9-20240828","first-page":"334","article-title":"A simple and safe technique for open insertion of umbilical cannula at laparoscopy","volume":"62","author":"Bhandarkar","year":"2000","journal-title":"Indian J Surg"},{"key":"R6-9-20240828","doi-asserted-by":"crossref","first-page":"305428","DOI":"10.1155\/2012\/305428","article-title":"Comparison of two entry methods for laparoscopic port entry: Technical point of view","volume":"2012","author":"Toro","year":"2012","journal-title":"Diagn Ther Endosc"},{"key":"R7-9-20240828","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.jmig.2014.10.023","article-title":"Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets","volume":"22","author":"Cuss","year":"2015","journal-title":"J Minim Invasive Gynaecol"},{"key":"R8-9-20240828","first-page":"CD006583","article-title":"Laparoscopic entry techniques","volume":"1","author":"Ahmad","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"R9-9-20240828","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4103\/0974-1216.51902","article-title":"Entry complications in laparoscopic surgery","volume":"1","author":"Krishnakumar","year":"2009","journal-title":"J Gynecol Endosc Surg"},{"key":"R10-9-20240828","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s004640000337","article-title":"Trocar and Veress needle injuries during laparoscopy","volume":"15","author":"Sch\u00e4fer","year":"2001","journal-title":"Surg Endosc"},{"key":"R11-9-20240828","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s00464-002-8872-0","article-title":"Diagnostic laparoscopy","volume":"18","author":"Udwadia","year":"2004","journal-title":"Surg Endosc"},{"key":"R12-9-20240828","first-page":"371","article-title":"Laparoscopic surgery in the developing world. An overview of the Indian scene","volume":"80","author":"Udwadia","year":"1995","journal-title":"Int Surg"},{"key":"R13-9-20240828","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/BF00705738","article-title":"Patient position for laparoscopic surgery","volume":"8","author":"Udwadia","year":"1994","journal-title":"Surg Endosc"},{"key":"R14-9-20240828","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1046\/j.1365-2508.1999.00333.x","article-title":"Safe insertion of trocars and Veress needle using standard equipment and the 11 security steps","volume":"8","author":"Semm","year":"1999","journal-title":"Gynaecol Endosc"},{"key":"R15-9-20240828","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1097\/00003081-200206000-00018","article-title":"Complications of laparoscopic surgery","volume":"45","author":"Magrina","year":"2002","journal-title":"Clin Obstet Gynecol"},{"key":"R16-9-20240828","first-page":"369","article-title":"Training and credentialling for laparoscopic surgery in the developing world","volume":"80","author":"Udwadia","year":"1995","journal-title":"Int Surg"},{"key":"R17-9-20240828","first-page":"48","article-title":"The relationship of the umbilicus to the aortic bifurcation: Implications for laparoscopic technique","volume":"80","author":"Hurd","year":"1992","journal-title":"Obstet Gynaecol"},{"key":"R18-9-20240828","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/S1074-3804(05)60614-7","article-title":"Safe technique for laparoscopic entry into the abdominal cavity","volume":"8","author":"Roy","year":"2001","journal-title":"J Am Assoc Gynecol Laparosc"},{"key":"R19-9-20240828","first-page":"1","article-title":"Safety in laparoscopy","volume":"13","author":"Palmer","year":"1974","journal-title":"J Reprod Med"},{"key":"R20-9-20240828","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.gmit.2013.07.003","article-title":"Principles of safe entry in laparoscopic gynaecological surgery","volume":"2","author":"Thepsuwan","year":"2013","journal-title":"Gynaecol Minim Inv Ther"},{"key":"R21-9-20240828","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1089\/gyn.2016.0111","article-title":"Complications of laparoscopy in connection with entry techniques","volume":"33","author":"Alkatout","year":"2017","journal-title":"J Gynecol Surg"},{"key":"R22-9-20240828","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1002\/bjs.4203","article-title":"Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery","volume":"90","author":"Merlin","year":"2003","journal-title":"Br J Surg"},{"key":"R23-9-20240828","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jmig.2005.01.011","article-title":"An evaluation of four test used to ascertain Veress needle placement at closed laparoscopy","volume":"12","author":"Teoh","year":"2005","journal-title":"J Minim Invasive Gynecol"},{"key":"R24-9-20240828","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1046\/j.1365-2508.1999.00299.x","article-title":"Complications of first entry: A prospective laparoscopic audit","volume":"8","author":"Richardson","year":"1999","journal-title":"Gynaecol Endosc"},{"key":"R25-9-20240828","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1046\/j.1365-2508.1999.00342.x","article-title":"How much gas is required for initial insufflation at laparoscopy?","volume":"8","author":"Phillips","year":"1999","journal-title":"Gynaecol Endosc"},{"key":"R26-9-20240828","first-page":"282","article-title":"Measurement of the force necessary for laparoscopic trocar entry","volume":"94","author":"Corson","year":"1994","journal-title":"J Reprod Med"},{"key":"R27-9-20240828","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1046\/j.1365-2508.1999.00310.x","article-title":"Towards evidence based laparoscopic entry techniques: Clinical problems and dilemmas","volume":"8","author":"Garry","year":"1999","journal-title":"Gynaecol Endosc"}],"container-title":["Journal of Minimal Access Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.JMAS_235_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:25:23Z","timestamp":1787844323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.JMAS_235_20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/jmas.jmas_235_20","relation":{},"ISSN":["0972-9941"],"issn-type":[{"value":"0972-9941","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}