Page 35 - World Journal of Laparoscopic Surgery

WJOLS

Various Port-site Closure Techniques in Laparoscopic Surgeries
First Group suture are inserted through all the layers of fascia one
on side of port-wound under laparoscopic visualization.
In this group, port closure is performed from inside the The needle and suture are placed exactly in the middle
abdomen under direct abdomen under direct visualiza-
tion of telescope, so as to avoid visceral injuries. They of one side of port-wound. The assistance grasps the
suture from another 5 mm port and needle is removed;
include maciol needles, grice needle, catheter or spinal
needles, modified veress needle with a slit made in then suture feeded into abdominal cavity of about 10 to
15 cm length. Then a 5 mm grasping forceps is inserted
retractable brunt tip, prolene 2/0 on straight needle aided
by a veress needle, straight needle armed with suture, through subxiphoid or other port and suture removed
from abdominal cavity. These four steps are repeated by
modified veress needle bearing a crochet hook at tip, and
Veress needle loop technique. 12 passing another preloaded angiocath needle and suture
through midpoint of other side of trocar-wound. Ends
Grice Needle of the suture are tied together with square knots. Knot
is then reduced into peritoneal cavity by pulling on one
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It was used by Stringer et al It was inserted into the or both ends of tied suture. The fascia is then closed and
abdomen at an angle by the side of trocar site to close. suture tied under direct vision through laparoscope.
Then under direct telescopic vision the needle was
placed through both peritoneum and fascia. Within Veress Needle Loop Technique
abdomen, the suture was grasped and removed from
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Grice needle with a grasper inserted from opposite Hamood and Mishra used it making a loop by passing
trocar. The Grice needle was then removed and rein- nylon suture to Veress needle and tied it. Then load the
serted at opposite site of previous puncture at an angle Vicryl suture to Veress needle tip and push the Veress
to trocar site. The suture was again grasped with needle with loop through abdominal wall without
Grice needle and pulled out of the abdomen. After piercing the skin, 3 mm away from the trocar site. Then
complete removal of trocar, the suture was tied under remove the Veress needle, leaving the Vicryl inside only
direct laparoscopic visualization. by putting a finger on Vicryl, grasped Vicryl by grasper
and pass it to other side of trocar to push it inside the
Maciol Needles Veress loop. Then after piercing the abdominal wall,
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Contarini used these needles. They are a set of three leave the skin and then remove the trocar close to the
needles which include two black handled introducers, wall by knotting.
one straight and one curved, and a golden-handle The 5 mm Trocar Technique
retriever. The introducer needle is used to pass suture
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through abdominal wall into peritoneal cavity from Chapman developed a simple technique using curved
subcutaneous tissue. The retriever needle (needle with a needle and sutures for closure of rectus sheath defects at
barb) is then passed into abdomen on opposite side of the trocar-wounds. First, with 5 mm telescope the defect is
defect to retrieve suture, and then pulled back through inspected from inside of abdomen and then pass a hemo-
tissue. The procedure is performed under direct tele- stat through the incision. Then under direct laparoscopic
scopic visualization before trocar withdrawal and does vision the peritoneum and rectus sheath are grasped and
not require skin incision enlargement. pulled through incision, thus by facilitating the passage
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of needle. Chatzipapas et al developed a similar closure
Vein Catheter, Spinal Needle, and Angiocath technique using standard suture with straight needles,
Vein catheter, spinal needle, and angiocath were used a 5 mm laparoscopic grasper, and a 4 mm hysteroscope.
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by Nadler et al under direct laparoscopic visualiza-
tion. No.0 polypropylene suture is threaded through Second Group
a 15 gauze needle and inserted along the umbilicus at The port to be closed is under direct vision of the surgeon
an angle of 45° from the distance of 0 to 5 to 1 cm. After in this group and for this purpose good insufflation of
piercing an endograsp, forceps is used to pull the free abdomen is a prerequisite. But if desufflation is per-
edge of suture edge into abdomen. It goes all around formed, then a tactile feedback should be used to close
umbilicus, penetrated all layers of subcutaneous tissue the port-wound. These techniques are applicable during
including fascia, and create a purse-string suture by insufflation and desufflation. They include suture carrier,
continuously running stitches. The whole procedure is the dual hemostat technique, the Lowsley retractor, and
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repeated three times until the purse-string stitch is made. application of bioabsorbable hernia plug in trocar sites.
For use of angiocath, a 14 gauze angiocath is used with It included preliminary fascial stay-suture placement
a 50 cm no.0 braided polyglactin suture. Angiocath and above and below trocar-wound, Foley’s catheter threaded
World Journal of Laparoscopic Surgery, September-December 2016;9(3):138-141 139