Task Analysis Of Laparoscopy Port Site Closure Using Veress Needle
Shilpa Kulkarni
Laparoscopic port site closure is recommended to prevent port site hernias. The incidence of port-site hernia is 0.02% to 5 % with an average of 1%. For 5mm port the incidence of hernia is 0.25%, 10 mm is 0.5%-2%, 12mm is 5%, 15mm is 20%. Thus, the recommendation is all ports greater than 10mm midline or lateral should be closed at a fascial level under laparoscopic vision.
There are many methods of port closure, the choice of method will depend on the individual patient characteristics, number, and size of ports and the surgeon’s preference. Closure using veress needle is quick, easy to perform, safe, inexpensive and provide adequate closure of fascia and peritoneum.
Parts of veress needle: Veress needle consists of an outer cannula with beveled needlepoint for cutting through the tissue and inner stylet loaded with spring. For port site closure we use the outer cannula of the veress needle. Suture material used are delayed absorbable or non-absorbable monofilament like proline.
Steps are as follows:
1. Remove the stylet from the cannula of veress needle.
2. Pass a suture material through the cannula from the tip to get it out from the other end.
3. Tie both the ends together to form a loop and hide the knot in the cannula.
4. Take another suture material which will be used to close the port site, pass about 2cms of this suture through the same cannula tip.
5. Now hold the veress needle with both suture materials like a dart, now verees needle is ready to be used for closure.
6. Occlude the port site with a gloved finger or keep the cannula in situ to maintain the pneumoperitoneum.
7. Now take the prepared veress needle, hold it like a dart and pierce at 30-450 angle beside the gloved finger or the cannula, within the upper edge of the incision, from subcutaneous tissue through layers of the abdomen into the peritoneal cavity under laparoscopic vision.
8. Once the tip is inside the peritoneal cavity, the suture is released by retracting the verees needle with a finger pressed over the suture on the abdominal wall, so that suture does not retract with veress.
9. Next veress needle is passed similarly through the opposite side of incision 1800 from the initial insertion site. Entangle the suture left in the abdomen in the loop of veress needle.
10. Tighten the loop of verses and retract the veress needle along with the suture.
11. So, the two ends of the suture are outside the abdominal cavity now.
12. A gloved finger from the port site is removed, pneumoperitoneum is released completely, then the suture ends are tied.
13. Thus, the port site incision is closed including peritoneum and fascia.