Page 30 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE Different Port Closure Techniques in Laparoscopy Surgery

Different Port Closure Techniques in

Laparoscopy Surgery

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1 Majid A Hamood, RK Mishra
1 Department of Surgery, Hilla Teaching Hospital, PO Box 294, Babil, Hilla, Iraq
2 Department of Surgery, Laparoscopy Hospital, New Delhi, India

Abstract
Introduction: Any new surgical procedure, face a new technical challenges, although minimally invasive surgery cause evident reduction
of the pain to the patient postoperatively, with better cosmesis, but with time, new challenges appears.
One of challenges is port closure techniques, in order to prevent the trocar site hernias and other complications .
Aims: The aim of this study to review and list different techniques used for closure of the trocar sites.
Methods: A literature search was performed for articles and text books dealing with techniques of closure. The author searched this
subject using Medline and the search engine Google, Springerlink and High wire Press. The following search term were used; port site
closure techniques. Review, All articles reporting techniques with their references were reviewed with some text books.
Results: in this literature review we described many techniques in addition to classical closure using curved needles, including Grice
needle, Maciol-needles, endoclose device.
Carter-Thomason device, Tahoe ligature device, Endo-Judge device, exit puncture closure device, Owsley retractor, spinal cord
needles, dual hemostat, Veress needle loop technique,suture carrier, Riverdin and Deschamps needles, and Gore-Tex closure device.
Semm's emergency needle with adistal eyelet; the modified Veress needle with a slit made in the retractable brunt tip; dental awl with
aneye; prolene 2/0 on a straight needle aided by a Veress needle; a straight needle armed with suture; Auto stitch (United States
Surgical), a modified Veress needle bearing a crochet hook at the tip. Foley catheter threaded through the port hole forthe elevation of
fascial edge upon traction; fish-hook needle improvised out of a hypodermic needle by bending it 180°; Grooved director; U-shaped
purse-string suture placed in the fascia around the port hole .
Conclusion: Although there are different techniques used to close the trocar site, all of them are effective in closing the defect in the
fascial layers of the abdominal wall, two main groups of techniques were found.
Keywords: Port closure, techniques, complication, laparoscopy surgery.

INTRODUCTION be closed, incorporating the peritoneum into the fascial
closure. 10,18-20 Standard suture techniques can be difficult and
Around 200 years ago, endoscopy was first started with the frustrating, often involving blind closure of the fascial defect.
help of tin tube at the end of which candle was placed to provide A number of techniques and devices have been developed to
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the illumination. The modern area of laparoscopy started in
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1966 with the development of Hopkin's-Rod system. The facilitate this fascial closure.
introduction of any surgical procedure brings with it new METHOD
technical challenges. Because laparoscopy offers patients a
reduction in pain and better cosmesis, it is being used more Selected papers were screened for further references. Criteria
frequently today. Laparoscopy allows for more intricate for selection of literature were the number of cases (excluded if
procedures to be performed, but larger ports are required to less than 20), methods of analysis (statical or nonstatical),
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execute such complex surgeries. Along with larger ports come operative procedure (only universally accepted procedures were
larger abdominal incisions and thus an increase in the possibility selected) and the institution where the study was done
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of complications following surgery. These complications can (specialized institution for laparoscopic surgery). Textbooks of
include incisional bowel herniation as well as small bowel laparoscopic surgery also were reviewed.
4,5
obstruction. The closure of laparoscopic trocar sites is helpful
6,7
in reducing such complications. In 1968, Fear was the first to RESULTS
report ventral hernia at a trocar site after laparoscopy. Trocar Port closure techniques could be classified from a technical
complications occur in approximately 1 to 6% of patients. 8-16 point of view into two groups:
Herniation associated with laparoscopic trocar sites can occur
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with incisions as small as 3 mm. It is recommended that all 10 1st group: With laparoscopic visualization (Must be seen
and 12 mm trocar sites in adults and all 5 mm port sites in children through telescope).
World Journal of Laparoscopic Surgery, September-December 2009;2(3):29-38 29