A Hasson port is the blunt-tipped trocar used during the open-entry technique for laparoscopic surgery, first described by Harrith Hasson in 1971. Instead of blindly puncturing the abdominal wall with a sharp needle or trocar, the surgeon cuts down through each tissue layer under direct vision, then slides the blunt cannula into the abdominal cavity before inflating it with carbon dioxide gas. The technique was designed to avoid the vascular and bowel injuries that can happen when a sharp instrument enters the abdomen without the surgeon being able to see what is on the other side. Decades of research have failed to prove that any single entry method is definitively safer than the others across all patients, but the Hasson port remains the go-to choice in several high-risk scenarios where blind entry feels like an unnecessary gamble.
How the Open Entry Technique Actually Works
The procedure starts with a small incision, usually about one to two centimeters, just below the navel. The surgeon pushes through the subcutaneous fat to find the umbilical stalk, the fibrous remnant of the umbilical cord, and follows it down to where it meets the tough midline tissue called the linea alba. This junction matters because it is the spot where the peritoneum (the membrane lining the abdominal cavity) reliably sticks to the overlying fascia, making it the thinnest and most predictable point of entry. Stay sutures are placed above and below this spot, primarily to make closing the port site easier at the end of the operation. A very small nick, less than five millimeters, is then made through the fascia and peritoneum. The surgeon can use a fingertip or blunt forceps to widen the opening slightly and feel for any adhesions stuck to the inner abdominal wall. Only then is the blunt-tipped cannula inserted under direct vision.1PubMed Central. A Safe Quick Technique for Placement of the First Access Port for Creation of Pneumoperitoneum
Once the cannula is seated, the gas line is connected and the abdomen is inflated with carbon dioxide to create a working space. Additional trocars for the camera and instruments are placed under direct laparoscopic vision after that first port is established. The entire rationale of the Hasson technique rests on this first step: because the surgeon can see and feel every layer before entering the peritoneal cavity, the risk of accidentally puncturing a blood vessel or loop of bowel during initial access drops substantially.
When Surgeons Reach for the Hasson Port
Open entry is not automatically used for every laparoscopic case. Many surgeons default to the Veress needle (a spring-loaded, sharp-tipped needle that punctures through the abdominal wall in one motion) for straightforward operations on patients without complicating factors. The Hasson port tends to come out for patients whose anatomy makes blind entry risky: people with multiple prior abdominal surgeries, severe endometriosis, a history of pelvic inflammatory disease, or previous tubo-ovarian abscess.2Annals of Clinical Case Reports. Laparoscopic Entry, But How? The concern in all these situations is adhesions, bands of scar tissue that can glue loops of bowel or other organs to the inner surface of the abdominal wall right where a blind instrument would land.
A study of patients with upper abdominal surgical scars found that open introduction of the primary trocar in an area expected to be free of adhesions allowed safe laparoscopic cholecystectomy without conversions to open surgery or complications.3Australian and New Zealand Journal of Surgery. Laparoscopic Cholecystectomy and Previous Abdominal Surgery: A Safe Technique A larger series of over 800 patients using a modified Hasson technique reported no visceral or vascular injuries at all, with the only notable complication being a small number of patients who developed temporary wound drainage.4PubMed. A safe and simple method for routine open access in laparoscopic procedures
A review of abdominal entry techniques put it plainly: open entry can be more technically challenging than the alternatives, but it is probably the best option for patients with suspected intra-abdominal adhesions.5PubMed. Clinical Perspective Concerning Abdominal Entry Techniques
Safety Compared to the Veress Needle
The debate over Hasson versus Veress entry has been running for decades, and the honest summary is that neither method has convincingly beaten the other in large studies. In a retrospective review of over 3,000 laparoscopic cases, the Veress needle was used in about 1,900 patients with an entry-related complication rate of roughly 0.1% (two colonic injuries), while open port insertion was used in about 1,200 patients with a complication rate of roughly 0.08% (one small bowel perforation).6PubMed Central. Establishing pneumoperitoneum: Verres or Hasson? The debate continues Those numbers are so low on both sides that statistical comparisons struggle to find meaningful differences.
A comparative study looking at routine laparoscopic cholecystectomy concluded that both methods are equally safe in terms of major complications.7Minimally Invasive Surgery. A Study of the Safety and Morbidity Profile of Closed versus Open Technique of Laparoscopic Primary Peritoneal Access Port Another comparison that explicitly set out to determine a “safety index” between the two found that neither group experienced any major injuries related to primary trocar insertion.8PubMed Central. The Hasson Versus Veress Trocar Wars: Determining the Safety Index of Laparoscopic Surgical Entry Techniques A study comparing the two methods for establishing pneumoperitoneum found that the open method had fewer access-related complications, while postoperative pain and minor complications were comparable between both groups.9Greenfort International Journal of Applied Medical Science. The Comparative Study of Intra-peritoneal Access by Open Versus Closed Method to Create Pneumoperitoneum in Laparoscopic Surgery
The pattern across the literature is consistent: entry-related injuries during laparoscopy are rare regardless of method, and no high-quality evidence suggests any single approach offers a universal safety advantage.10PubMed. Clinical Perspective Concerning Abdominal Entry Techniques Surgeon experience and patient selection seem to matter more than the choice of hardware.
The Gas Leak Problem
One well-known drawback of the Hasson port is gas leakage. Because the surgeon cuts a deliberate opening through the abdominal wall rather than making a tiny needle puncture, the fit between the cannula and the surrounding tissue is not always airtight. Carbon dioxide can escape around the port, making it harder to maintain the inflated abdominal space needed for the surgeon to see and work. The rate of gas leakage reported in the literature ranges from about 4% to 14%.11Global Library of Women’s Medicine. Open Laparoscopy
Surgeons have come up with a range of workarounds. Various redesigned Hasson trocars include inflatable balloons or cone-shaped sleeves to create a better seal. When those are not available or do not work, practical fixes like placing towel clamps around the incision, packing Vaseline gauze around the cannula, or tying a purse-string suture around the port site are common.12Global Library of Women’s Medicine. Open Laparoscopy The leakage is rarely a reason to abandon the procedure, but it can be a nuisance that slows things down, particularly during longer operations.
Port-Site Hernias
Anytime you cut a hole through the abdominal wall, there is a chance that a hernia develops at that spot later. Port-site hernias after laparoscopic surgery are uncommon overall, but they do happen, and the Hasson port site is one of the places they are most likely to appear. The strongest single risk factor is port size: incisions larger than 10 millimeters carry higher hernia rates. Open entry technique is also associated with increased risk compared to closed techniques, along with factors like older age, obesity, poor nutrition, and wound infection.13PubMed Central. Laparoscopic Port Site Hernias
In a study of bariatric surgery patients, the incidence of hernia at the Hasson port site that required surgical repair was about 1.2%.14PubMed. VersaStep trocar hernia rate in unclosed fascial defects in bariatric patients One of Hasson’s own large reviews, covering over 5,200 women who had open laparoscopy, reported one umbilical hernia requiring surgery among the group.15Obstetrics & Gynecology International Journal. Laparoscopic entry in obese patients: Jain point
Whether the fascia gets sutured closed at the end of the procedure matters a great deal. A review of laparoscopic cholecystectomy data found that when fascial closure was performed in all patients regardless of entry method, the incidence of postoperative hernia was nearly identical between the open group (about 0.7%) and the closed group (about 0.8%).16PubMed Central. Port-Site Hernia Following Laparoscopic Cholecystectomy The stay sutures placed during the original Hasson entry actually make closing the fascia easier than trying to find and stitch the fascial edges after a blind trocar insertion, which is a practical advantage that gets overlooked in the hernia discussion.
Open Entry and Obesity
Obese patients present a specific challenge for the Hasson technique. The thicker the abdominal wall, the deeper the surgeon has to cut to reach the fascia and peritoneum, and the harder it becomes to maintain a seal around the port. The typical Hasson incision of about two centimeters can turn into a deeper, more difficult dissection when there is a substantial layer of subcutaneous fat. This contributes to a higher incidence of port-site hernia in heavier patients and greater difficulty maintaining pneumoperitoneum throughout the operation.17Obstetrics & Gynecology International Journal. Laparoscopic entry in obese patients: Jain point
Alternative entry points have been proposed specifically for obese patients. One approach uses the “Jain point” in the left upper quadrant, where the abdominal wall tends to be thinner even in people with significant central obesity. Other surgeons prefer optical trocars for obese patients. In a study of obese women (average BMI around 35), a bladeless optical trocar achieved entry in a mean time of roughly 72 seconds versus about 215 seconds for the open Hasson technique, with slightly fewer minor injuries in the optical trocar group.18PubMed Central. Bladeless Direct Optical Trocar Insertion in Laparoscopic Procedures on the Obese Patient The time difference is notable enough that many bariatric surgeons have moved toward optical entry systems for their routine cases, though they tend to keep the Hasson technique in their back pocket for revision surgeries where adhesions are expected.
Speed and the Rise of Optical Trocars
The Hasson technique is not fast. Cutting through each layer, placing stay sutures, digitally sweeping for adhesions, and threading the blunt cannula under direct vision takes more time than simply pushing a needle or trocar through the abdominal wall. A study in urologic surgery measured the mean entry time for a Hasson port at about 95 seconds, compared to roughly 38 seconds for a Visiport optical trocar system. No complications were seen in the Hasson group, while 8% of the optical trocar patients had complications.19PubMed Central. Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery A similar comparison in gynecologic surgery found that direct optical access significantly reduced entry time and blood loss compared to the Hasson method, though major complication rates were not significantly different.20PubMed. Abdominal access in gynaecologic laparoscopy: a comparison between direct optical and open access
Modified open techniques have tried to close this speed gap. One modified Hasson approach reported a mean entry time of about two minutes in a series of over 150 patients, with port-site seroma and infection each occurring in about 0.6% of cases and no visceral or vascular injuries.21International Surgery Journal. Modified Hasson technique: a quick and safe entry of first port into the abdomen Another modified open technique reported a mean entry time of about three minutes, with a port-site infection rate of about 2% and a hernia rate of 1%.22Bangladesh Medical Journal. Modified Open Technique for First Port Insertion in Laparoscopic Surgery
The trade-off pattern is consistent: optical and direct trocars get you in faster, but the Hasson approach tends to produce fewer complications per entry. Whether those extra seconds or couple of minutes matter depends on the operation and the patient. For a straightforward cholecystectomy on an otherwise healthy person, shaving a minute off entry time is a minor convenience. For a complex revisional surgery where you expect dense adhesions behind the abdominal wall, speed at entry is the last thing on the surgeon’s mind.
Pregnancy and Laparoscopic Entry
Laparoscopic surgery during pregnancy, most commonly for appendicitis or symptomatic gallstones, raises unique entry concerns because the uterus displaces abdominal organs and changes the geography of the peritoneal cavity. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines state that initial abdominal access can be safely accomplished with an open (Hasson), Veress needle, or optical trocar technique by experienced surgeons, as long as the entry location is adjusted for fundal height.23Surgical Endoscopy. Guidelines for the Use of Laparoscopy during Pregnancy
A systematic review of laparoscopic versus open appendicectomy in pregnancy found that entry-related complications occurred in about 2.8% of Veress needle cases but 0% in the Hasson open entry group.24PubMed. Laparoscopic versus open appendicectomy in pregnancy: a systematic review That is a small dataset and should not be over-interpreted, but it reflects the theoretical advantage of open entry when a large gravid uterus sits in the path of a blind puncture. Many surgeons who routinely use the Veress needle in non-pregnant patients will switch to the Hasson technique for pregnant patients, especially in the second and third trimesters when the uterus extends well above the umbilicus.
Newer Modifications and Sutureless Variants
The classic Hasson technique has been around for over fifty years, and surgeons have been tinkering with it the entire time. One of the common complaints is that the stay sutures placed during entry are fiddly and time-consuming. A recently described “S-open” technique eliminates the fascial sutures entirely. In a series of 76 patients, entry was successful in every case, complications were rare and minor, and no trocar-site hernias were recorded during follow-up ranging from four months to two years.25PubMed Central. S-open Technique: A Novel, Sutureless, Open Laparoscopic Entry Technique The idea behind sutureless variants is to keep the safety advantages of seeing each tissue layer during entry while reducing the setup time and fuss that make the classic Hasson technique slower than closed methods.
Other modifications focus on the port hardware itself. Balloon-tipped cannulas create a better seal against the peritoneum and reduce gas leakage. Radially expanding trocars stretch the fascia rather than cutting it, which may reduce hernia risk. Some centers use a hybrid approach: they perform an open cut-down to the fascia, then insert an optical trocar through the last few layers under camera vision. Each modification tries to solve a specific complaint about the original technique without giving up its core advantage of controlled, visualized entry.
Reusable Versus Disposable Equipment
The Hasson cannula was originally designed as a reusable metal instrument, and many hospitals still use reusable sets. The cost difference between reusable and disposable laparoscopic instruments is substantial. A seven-year analysis of laparoscopic cholecystectomy found that disposable instrument sets cost about 6.4 times more per procedure than reusable ones, translating to savings of roughly £270 per case when the hospital used reusable trocars, ports, and clip applicators.26The Annals of The Royal College of Surgeons of England. Cost-Effective Laparoscopic Cholecystectomy The original blunt-tipped Hasson cannula, being a straightforward metal tube with a cone and retention suture wings, is among the simplest reusable instruments in the laparoscopic tray. In resource-limited settings, where disposable optical trocars may not be available or affordable, the Hasson technique with reusable instruments remains the most practical approach to safe laparoscopic entry.
Disposable versions of the Hasson-style port do exist, and some surgeons prefer them for the sharper threading and more reliable gas seal of a fresh device. But the economic argument for reusable equipment is hard to ignore when surgical departments are performing hundreds of laparoscopic procedures per year. The equipment choice often comes down to institutional purchasing agreements and sterilization infrastructure rather than any clinical superiority of one material over another.
Why No Technique Has Won the Debate
After more than five decades of comparison studies, editorials, and institutional preference wars, the laparoscopic entry debate remains unresolved for a simple statistical reason: the complications everyone is trying to prevent are extremely rare. Major vascular or bowel injuries during initial trocar placement happen in fewer than 1 in 1,000 cases with any method. To run a trial large enough to detect a meaningful difference between two events that each occur less than 0.1% of the time, you would need tens of thousands of patients in each arm. No one has done that, and it is unlikely anyone will. The studies that exist are mostly retrospective, relatively small, and conducted at single centers with surgeons who are already skilled in whichever technique they use, which introduces a bias toward good outcomes regardless of method.
What the accumulated evidence does allow is a rough consensus about who benefits most from each approach. Open entry suits patients with adhesion risk. Veress entry is quick and well-suited to patients with straightforward anatomy. Direct trocar entry under laparoscopic visualization may be underused and results in fewer failed entries.27PubMed. Clinical Perspective Concerning Abdominal Entry Techniques Optical trocars offer speed advantages in obese patients. Most experienced laparoscopic surgeons are comfortable with more than one technique and choose based on the patient in front of them rather than dogma. The Hasson port, for all its age and its drawbacks, occupies a role that no newer device has fully replaced: it is the method you use when you want to see every layer of the abdominal wall before you commit to entering the peritoneal cavity, and that cautious philosophy keeps it relevant in an era of increasingly sophisticated hardware.