New closure technique for lateral operative laparoscopic trocar sites

Abstract

The reported frequency of incisional hernias, after operative gynecological laparoscopy, at extraumbilical trocar sites is one per 32 puncture sites created by a 12-mm trocar. A new closure technique of suturing with the Grice Needle (Ideas for Medicine, Inc., Clearwater, FL) before removing the trocars was utilized to close 80 lateral trocar sites (42 consecutive laparoscopic myomectomies). The trocar sizes in this study were 12 mm and 18 mm. This is the largest reported series of lateral trocar-site closures. No hematomas or bleeding or incisional hernias have resulted from use of this technique. This closure allows the surgeon to completely close both peritoneum and fascia, of the lateral trocar sites, under direct laparoscopic visualization without the loss of pneumoperitoneum or risk of inadvertent injury to the small bowel.

Port closure techniques

“…Stringer et al [44] reported using the Grice needle (Ideas for Medicine, Inc., Clearwater, FL, USA) to close 80 lateral trocar sites (42 consecutive laparoscopic myomectomies) A Grice needle (Fig. 2) was inserted at an angle along the side of a lateral trocar.…”

“…Trocar complications occur in approximately 1% to 6% of patients [4,7,10,19,21,22,33,37,44]. Herniation associated with laparoscopic trocar sites can occur with incisions as small as 3 mm [2].…”

Various Port-site Closure Techniques in Laparoscopic Surgeries

“…It was used by Stringer et al 13 It was inserted into the abdomen at an angle by the side of trocar site to close. Then under direct telescopic vision the needle was placed through both peritoneum and fascia.…”

Safety and efficacy of 12‐mm radial dilating ports for laparoscopic access

“…Herniation of omentum [19] and bowel [20] are well‐documented postoperative risks of laparoscopy. Factors include the use of ports of ≥ 10 mm, the use of ‘fascial screws’ to secure the port, and a longer procedure [21]. Alternative techniques to close the fascia, e.g.…”