Page 34 - World Journal of Laparoscopic Surgery

WJOLS

MK Medha 10.5005/jp-journals-10033-1291
REVIEW ARTICLE

Various Port-site Closure Techniques

in Laparoscopic Surgeries

MK Medha

ABSTRACT Minimally invasive surgeries are the advantageous and
Introduction: Minimally invasive surgeries are the advantageous cosmetically better surgical procedures nowadays. But
and cosmetically better surgical procedures nowadays. But laparoscopic trocars do create wounds. So any surgeon,
laparoscopic trocars do create wounds. It is necessary to close whether a neophyte or an expert, needs a systematic
these wounds with a good technique in order to decrease the
complications related to port-site complications, especially hernia. approach to exit the abdomen after any laparoscopic
Aim: This study is to review and list different techniques used procedure. It is necessary to close these wounds with a
for closure of port-site wounds. good technique in order to decrease the complications
Materials and methods: A literature search was performed for related to port-site complications, especially hernia.
the articles related with techniques of closure of trocar sites. For Precise anatomical closure of abdominal wall fascia
this purpose, the search engines used were Google, HighWire of port sites 10 mm or larger is mandatory. Because larger
Press, and SpringerLink. Only those techniques that include
the usage of suture materials, suture carriers, and various ports can cause increase in possibility of complication
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needles were reviewed in this study. Special devices made for following surgery. These complications include inci-
port-closure are not reviewed here. sional bowel herniation as well as bowel obstruction.
3,4
Results: The study describes many techniques, including clas- Many techniques and devices have been introduced
sical closure using curved needles, such as the Grice needle,
Maciol needles, spinal needles, dual hemostat, suture carrier, into practice to minimize risk of port-site complications
5,6
modified Veress needle with a slit made in retractable brunt tip, which occur in 1 to 6% of cases. It is recommended that
dental awl with an eye, prolene 2/0 on straight needle aided all 10 and 12 mm trocar sites in adults and all 5 mm port
by Veress needle, straight needle armed with suture, modified sites in children be closed, incorporating peritoneum
Veress needle bearing a crochet hook at tip; Foley catheter
threaded through port-hole for elevation of fascial edge upon into fascial closure. 7-10 A number of techniques have
traction; fish-hook needle improvised out of a hypodermic been developed in an attempt to prevent trocar-site
needle by bending it to 180°; U-shaped purse-string suture hernia, but there is still no gold standard. Traditional
placed in the fascia around port-hole.
Conclusion: There are plenty of techniques for closure of suturing techniques have been used, but proven to be
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trocar-site wounds, all of them are effective in closing the fascial blind closure of fascial defect. Therefore, many modi-
defect of abdominal wall. fied techniques using various devices and needles have
Keywords: Laparoscopic surgeries, Port-site closure techniques, been developed to facilitate the aim of prevention of
Trocar-site hernia. trocar-site hernia.
How to cite this article: Medha MK. Various Port-site Closure
Techniques in Laparoscopic Surgeries. World J Lap Surg
2016;9(3):138-141. MATERIALS AND METHODS
Source of support: Nil A literature search was performed for the articles
Conflict of interest: None related with techniques of closure of trocar sites. For this
purpose, the search engines used were Google, HighWire
INTRODUCTION Press, and SpringerLink. The term used for search
In 1996, the modern era of laparoscopy started with the was port-site closure techniques. All the articles dealing
1
invention of Hopkin-Rod system by Professor Hopkins. with port-site closure methods were reviewed along with
their references.
Assistant Professor RESULTS

Department of Obstetrics and Gynecology, Sir Takhtasinhji
General Hospital and Government Medical College, Bhavnagar Port closure techniques can be classified from technical
Gujarat, India point of view into two groups:
Corresponding Author: MK Medha, Assistant Professor First group: Needle must be seen through telescope
Department of Obstetrics and Gynecology, Sir Takhtasinhji (laparoscopic visualization).
General Hospital and Government Medical College, Bhavnagar Second group: Needle must be seen by surgeon and no
Gujarat, India, e-mail: kananimedha@gmail.com
telescope required for it (no laparoscopic visualization).
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