Comparative outcomes of Palmer, Umbilical Veress needle, and open entry techniques in robotic-assisted surgery: a propensity-matched analysis of 9482 patients.

Robotic-assisted surgery offers several advantages over traditional methods, such as reduced blood loss and fewer complications. Establishing pneumoperitoneum is a critical step, with two primary techniques: the Veress needle (closed) and the Hasson (open) technique. Despite extensive studies in laparoscopic surgery, limited data exist regarding their use in robotic surgery. This study compares complication rates and predictors between Palmer, umbilical Veress needle, and open Hasson techniques in robotic surgery. In this retrospective cohort study of 9482 patients undergoing robotic surgery, we compared palmer, umbilical Veress needle, and Open Hasson techniques using propensity score matching. Primary outcomes were complication rates classified by the Clavien-Dindo system. We used logistic regression to analyze predictors of complications, such as needle attempts and adhesions. One thousand sixteen patients were matched between Palmer and umbilical groups and 310 between Veress needle and open groups. Umbilical insertion was associated with more complications than Palmer (OR 2.14, p = 0.033). Patients requiring more than four needle attempts had higher complication rates (OR 15.43, p = 0.002). Severe adhesions significantly increased complications. After adjustment, the choice of entry method was not independently associated with complications. Surgical entry complications in robotic-assisted surgery are more influenced by needle attempts and adhesions than by the choice of entry technique. Tailoring surgical plans based on patient characteristics and minimizing needle attempts can improve outcomes, underscoring the importance of individualized approaches over standardized methods.