Aneurysm Needle as an Effective Tool in Laparoscopic Port Closure

Abstract

The importance of port closure after laparoscopic surgeries is emphasized by the extensive number of techniques being described for the same. Even so, the search for a simple, time-saving, and effective technique still continues. One commonly overlooked factor is the obliquity of laparoscopic ports, which makes direct visualization of the rectus fascia through the skin incision difficult. Also, our patients, mostly of Indian ethnicity, tend to have relatively thick subcutaneous fat that again acts as a constraint during port closure. We have described a simple and effective method of laparoscopic port closure using Moynihan's aneurysm needle and a skin hook. This technique is particularly advantageous in the above-mentioned scenarios. We have been successfully using this technique in our institution for the past 6 years, and we have not encountered any case of port-site hernia. Our technique does not require expensive instruments or the need for visualization via a camera.

Efficacy and reliability of the use of a needle grasper to prevent trocar site hernia.

“…Our technique is easily applicable to obese and morbidly obese patients. Other techniques proposed necessitate the help of additional hand tools for intra-abdominal assistance, and their applicability in obese patients is difficult [ 22 – 25 ]. Extending the skin incision might be necessary, and fascia repair in obese patients is difficult with techniques using simple suture closure.…”

Effective, simple, easy procedure for laparoscopic port closure in difficult cases

“…The port closure techniques were classified by Shaher [3] into 3 groups: (a) techniques that use assistance from inside the abdomen (requiring 2 additional ports), (b) techniques that use extracorporeal assistance (requiring 1 additional port), and (c) closure techniques that can be performed with or without visualization (without additional ports). Some surgeons recommend the use of fascial closure devices such as spinal needle [14] , hypodermic needle [15] , Deschamps needle [9] , Berci's needle [16] , and aneurysm needle [17] to close the fascial defect with 0%–1% port site herniation incidence [18] . But, all these procedures are not suitable in obese cases (thick abdominal wall and oblique wound), need assistance from inside, the suture is placed from the port site, which needs to increase skin incision, and the suture passes near the edges of the fascial defect.…”