The purpose of this study is to compare the safety and complications of direct trocar insertion without pneumoperitoneum (DTI) with Veress needle (VN) in laparoscopic cholecystectomy (LC). We studied 84 patients admitted to our hospital for LC, in a random simple blind design, 42 patients were assigned to DTI and 42 to VN. The variables analysed were : procedure complications, laparoscope insertion time and duration of surgery. Complication percentages between the groups were significantly different (DTI 2.3% versus VN 23.8%, p = 0.009). The duration of surgery between the two groups was also significantly different (DTI 56+/-31 versus VN 71+/-28 minutes, p < 0.02). Finally, laparoscope insertion time between the two techniques was significantly different (DTI 1.5+/-0.5 versus VN 3.0+/-0.4 minutes p < 0.001). Our results show DTI to be a safe, efficient, rapid and easily-learned alternative technique, reducing the number of procedure-related complications.