Surgeons can improve access safety and efficiency with a novel manometric visualization technique for Veress needle entry.

• Pneumoperitoneum success rates were 99% across standard-weight patients with no complications in both test groups.
• The modified manometric technique reduced insufflation time to 1 minute, compared to 2 minutes with traditional methods (p < 0.001).

For obese patients, the four-forceps technique resulted in fewer failed entries (3% vs 15%) and reduced puncture attempts (median 1.0 vs 3.5, p = 0.019) without added complications.

These modifications enhance reliability and should be considered for diverse surgical populations.