Page 11 - World Journal of Laparoscopic Surgery

WJOLS

Percutaneous Transabdominal External Looped Needle for Peritoneal Closure
layer of abdominal wall and upper peritoneal flap. The
loop was pushed to release the Vicryl end from needle
Figs 1A to C: (A) Loop at the tip of stent inside the needle; (B) long tip. The Vicryl end was holed by laparoscopic forceps to
needle; and (C) metal stent inside the needle. This diagram of looped bring it outside the abdominal cavity through the same
needle and our technique needs two-looped needles
working port. The suture was tied extracorporeal or
intracorporeal (Figs 2A to H). Multiple sutures were put
in its position using Glubran 2 (Gem SrL, Viareggio, Italy).
The peritoneum was closed using Vicryl no. 0 by helping until good peritoneal closure was achieved (Figs 3A to C).
external looped needle through anterior abdominal wall. The pneumoperitoneum was emptied under direct view-
The looped needle was prepared by the corresponding ing with a laparoscope, and external pressure was applied
author, using long needle (15–20 cm) and inside it loop, to the inguinal region. The follow-up period ranged from
which can be pushed or pulled through the needle sheath 3 to 32 months (mean 28 months). The intra and postop-
to hold or release the thread (Figs 1 A to C). The looped erative complications were recorded.
needle passes directly from the anterior abdominal wall RESULTS
to the lower peritoneal flap. Then, the inside loop was
pushed to come out from the needle tip. One end of The mean age was 49.3 years (21–63 years), mean body

Vicryl no. 0 was passed through working port to put into mass index (BMI) was 24.5 (18.1–30.2), and mean opera-
the loop by laparoscopic forceps. The loop was pulled tive time was 100 minutes (90–120 minutes). The mean
to hold Vicryl end inside the needle. The needle with time to put one suture by this technique was 1.8 minutes
Vicryl and loop inside it is withdrawn for some distance (1.5–3 minutes). The mean number of sutures to achieve
and redirected by pushing to pass through the inner good peritoneal closure was seven sutures (5–9 sutures).

A B

C D
Figs 2A to D: (A) The looped needle passes directly from abdominal wall to abdominal cavity, then through the lower peritoneal flap;
(B) the stent and loop push through the needle to appear through the abdominal cavity. Then, the end of Vicryl no. 0 put inside the
loop by using laparoscopic forceps; (C) the stent and the loop are withdrawn to hold the Vicryl end inside the needle. The needle is
withdrawn to retract its tip at inner layer of anterior abdominal wall; and (D) Redirected and pushing of needle with Vicryl through inner
layer of abdominal wall and upper peritoneal flap was done
World Journal of Laparoscopic Surgery, May-August 2016;9(2):58-62 59