Hasson Vs. Veress — The Debate And Selection Of Pneumoperitoneum Techniques

https://en.wikipedia.org/wiki/Veress_needle

The safest method for initial abdominal entry remains debated in laparoscopic surgery. The two dominant techniques are the Veress needle technique (Closed/Blind technique) and the Hasson technique (Open technique). Understanding their respective merits guides optimal clinical decision-making.

Veress Needle Technique (Closed)

This is the "blind" method discussed herein. A small skin incision is made at the umbilicus, followed by Veress needle insertion to establish pneumoperitoneum before trocar placement.

• Advantages:​ Speed, minimal trauma (2–3 mm incision), less postoperative pain, faster recovery, and a manageable learning curve. It remains the most widely used global standard.
• Limitations:​ Relies heavily on surgeon experience and tactile feedback. Carries a theoretical risk of blind injury to viscera or vessels, particularly in patients with adhesions, morbid obesity, or pregnancy.

Hasson Technique (Open)

A direct-vision entry method. A larger incision (~10–15 mm) is made at the umbilicus. The surgeon dissects through the fascia under direct view, exposes the peritoneum, incises or lifts it, and inserts a blunt trocar with an inflatable anchoring cuff, which is then sutured in place.

• Advantages:​ Eliminates blind penetration risks entirely. Preferred for patients with prior abdominal surgery (suspected adhesions), morbid obesity (excessive wall thickness), or pregnancy.
• Limitations:​ More cumbersome, larger incision, higher risk of gas leakage, requires fascial closure, and adds operative time and trauma.

The Indispensability of the Veress Needle in Closed Technique

Despite Hasson's superiority in high-risk cohorts, its inefficiency in routine laparoscopic procedures (e.g., cholecystectomy, appendectomy, gynecologic surgeries) ensures the continued dominance of the closed technique. A premium Veress needle is the physical foundation of this success. Its refined conical profile ensures smooth passage through tiny incisions; precise depth markings (Length 80–150 mm) aid depth control; and the reliable spring safety tip provides the ultimate safeguard for closed-entry safety.

Clinical Decision Guidance

Novice surgeons should master the Veress technique under supervision to develop tactile acuity. For high-risk patients (e.g., history of lower abdominal surgery), abandon the Veress needle in favor of Hasson. For the vast majority of routine cases, the Veress technique remains the preferred first choice, perfectly embodying the minimally invasive ethos of "small incision, big solution."