Objective To compare the safety and complications of veress needle (VN) versus direct trocar insertion (DTI) techniques in laparoscopic procedures. Study design Comparative study. Place & Duration of study The study was conducted at three different hospitals in Karachi from October 2005 to May 2011. Methodology A total of 1050 consecutive laparoscopic surgeries were done during the study period. Female to male ratio was 2.5:1. In 73% of the cases direct trocar placement was done while in 27% pneumoperitoneum was achieved with Veress needle. Variables noted included technique, complications, and duration of surgery. Data was analyzed statistically using SPSS version 16. Results Female to male ratio was 2.5:1.Complications were more in direct trocar insertion method. Overall total complications were 3.4%. One percent in group I (VN technique) and 4% in group II (DTI technique) had complications (p=0.017). No visceral injuries were noted in either group, but pre-peritoneal insufflations found in 2 patients (0.25%) in group II. Late complications were more in group II. This include wound infection (1.5%), late wound bleeding (0.9%), port site hernia formation (0.9%) and chronic sinus formation (0.38%). All these were statistically insignificant except wound infection (p 0.036). Conclusion Veress needle method is as safe as direct trocar insertion method in expert hands.