“Recent reports by the Australian Safety and Efficacy Register for New interventions and Procedures (ASERNIP-S) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) concluded that insufficient evidence is available to assess the safety of the open versus closed laparoscopy in regard to major vascular and visceral injuries.” (Larobina & Nottle)

“Our case series shows that open laparoscopy can vastly reduce the incidence of access-related morbidity and mortality. Only a single visceral injury occurred in 5900 cases, and no major vascular injuries were reported.These figures are consistent with those of other reported series of open laparoscopy, which also show a zero rate of vascular injury and low rates of visceral injury.The literature review showed a rate of 1 injury to major retroperitoneal vessels per 2272 cases of closed laparoscopy procedures. This compares with a major vascular injury rate of 0 for the open technique. This difference is both statistically significant ( P = 0.003) and highly clinically significant.” (Larobina & Nottle)

In Gaity et al.’s systematic review of Laparoscopic entry techniques, they found that “Comparison of closed techniques revealed a reduction in the risk of failed entry with use of a direct trocar entry technique in comparison to a Veress needle entry technique (8 RCTs; 3185 participants; moderate‐quality evidence). Here the evidence suggests that for every 1000 patients operated on, 65 patients in the Veress needle group will experience failed entry compared to between 11 and 22 patients in the direct trocar group (i.e. between 43 and 54 fewer incidents of failed entry occurred per 1000 patients operated on with a direct trocar vs a Veress needle). Evidence was insufficient to show whether there were differences between groups in vascular injury, visceral injury, solid organ injury, or other major complications.”

“Overall, evidence is insufficient to support the use of one laparoscopic entry technique over another. Researchers noted an advantage of direct trocar entry over Veress needle entry for failed entry. No study in any comparison reported any deaths.” (Gaity)

Larobina, Marco, and Peter Nottle. “Complete evidence regarding major vascular injuries during laparoscopic access.” Surgical laparoscopy, endoscopy & percutaneous techniques vol. 15,3 (2005): 119-23. Full Text at Emory.

Ahmad, Gaity et al. “Laparoscopic entry techniques.” The Cochrane database of systematic reviews vol. 1,1 CD006583. 18 Jan. 2019. Free Full Text.