I have a difficult time envisioning just what is happening directly deep to the fascia as the tip of a trocar penetrates in the case of direct insertion, because (someone help me out with this), since the peritoneal cavity is sealed without free air present wouldn't it be creating negative pressure to elevate the abdominal wall with eg. towel clips and simply pull viscera up with it? ie. One wouldn't really be creating a space devoid of viscera just under the fascia simply by pulling up on the abdomen, or would they? I sure wish I could see what insertion looked like from the inside (even using a Veress Needle in the traditional manner) because I don't really think we are creating an "air pocket" when we pull up, but instead are more or less making it easier for any organ that the tip of the needle (or trocar in the direct case) contacts to retreat away from the sharp tip. I suppose the bottom line is that if does prove (key word)to be safe to go in directly, we should consider it because after all, it would save a few minutes, and the costs of Veress needle and syringe of saline.