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

Abstract

IntroductionPort site herniation is one of the serious complications of laparoscopic surgery, which decreases its benefits. Closure of a fascia defect at the port site is an important problem of laparoscopic surgery, especially in obese patients.AimTo evaluate needle grasper fascia closure.Material and methodsWe closed the port site fascia using a percutaneous organ-holding device (needle grasper) in laparoscopic cholecystectomy patients. This study included 334 patients who underwent laparoscopic cholecystectomy between January 2015 and January 2017 in our hospital. Patients were divided into 2 fascia closure groups: group 1 with a standard simple suturing technique and group 2 with a needle grasper to close the port site. Patient demographics, operative details, and postoperative outcomes were collected and evaluated.ResultsThere were 243 female and 91 male (total 334) patients with the mean age of 49.18 ±13.15 years. Only 1 patient in the BMI > 30 kg/m2 group of patients had port site hernia development with the needle grasper technique at the end of the 8-month follow-up period. The port site hernia incidence was higher in group 1 than group 2 (p < 0.001), but there was no significant difference in terms of operation duration between the two groups (p < 0.001, p = 0.709, respectively). In patients with a BMI > 30 kg/m2, both operation duration and port site hernia incidence were higher in simple suture closure than in the needle grasper technique (p < 0.001, p = 0.016, p = 0.005).ConclusionsThe needle grasper technique is easy, simple, safe, fast, and effective for fascia closure of port sites. This method can also be applied in obese patients easily, safely and in a short time.

Preventing an 8-mm Port Site Hernia in Robot-Assisted Laparoscopic Surgery: Insights From Two Rare Cases and Future Preventive Measures

“…However, it is difficult to directly view the fascia and peritoneum at an 8-mm port, especially in cases with thick subcutaneous obesity. In such cases, it is sometimes difficult to suture the fascia from outside the body, so a direct visual closure of the fascia and peritoneum with the use of a laparoscope is also effective [15]. Since these two cases, we currently close all the fascia of 8-mm trocar sites with the laparoscopic extraperitoneal suture technique via a port closure needle (Endo Close™).…”

Thoughts on Trocar Site Hernia Prevention. A Narrative Review

“…A number of closure techniques of trocar sites are described, including direct visualisation and simple suture as a single stitch or a figure of 8 stitch (33). Various needle types, and techniques to pass sutures either blindly or under some vision are reported with good results on short term follow up (34)(35)(36)(37)(38)(39)(40). Incorporating haemostats into the suture closure is also described (41,42).…”