A New Technique for Fascia Closure

Introduction: Because of the risk of herniation, all port sites are recommended to be closed after laparoscopic surgery. However, port-site closure is difficult especially in obese case. Full-thickness closure of trocar wound is a time-consuming and frustrating task. A lot of devices for this closure have been introduced. However, they are not cost-effective. We report a new simple technique for this troublesome task.
Methods: An inner needle of 16-gauge venous catheter is used for this technique. To reduce the risk of bleeding and of cutting the suture, the tip of the needle is blunted by using something. A 75cm 2-0 absorbable bladed suture is placed through the needle. The both ends of the suture are pulled back in the direction of the hub. The trocar is removed. Pneumoperitoneum is maintained with a finger. The needle and the suture are introduced into the peritoneal cavity sufficiently through the fascia under laparoscopic monitoring. The needle is then pulled back slightly and a loop is made by the friction of the suture. A laparoscopic grasper is inserted into this loop through the trocar site. The needle still holding the suture is pulled out and is reintroduced into the peritoneal cavity through the opposite side of the fascia. The 2nd loop is made as described above. This loop is held and is pulled out from the trocar site through the 1st loop by the grasper. Next, the 1st loop is withdrawn outside the abdomen, and the 2nd loop and its edge come along with it. Finally, both edges of the suture are tied up to close the fascia.
Results: This technique was applied to both 5 mm and 12 mm trocar sites successfully. It took about 2 minutes to close each site.
Conclusion: This technique provides a simple, easy, and inexpensive fascia closure for all trocar sites after laparoscopic surgery.

Session: Poster

Program Number: P298

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