A novel technique of the 15-mm blunt trocar site closure in morbidly obese patients undergoing laparoscopic sleeve gastrectomy.

Obaida Batal, MD, Piotr Gorecki, MD. New York Methodist Hospital

This video describes the technique of a blunt trocar port-site closure, utilizing bipolar cautery.

As we can see in this video presentation – laparoscopic bipolar probe cautery is applied to the edges of the peritoneal opening. A motion of gradual closure of the edges of the bipolar instrument, along with the simultaneous application of the heat, causes thermal tissue coagulation at the trocar site, which results in the reduction of the size of the peritoneal and fascial defect. In addition, coagulated tissue at the trocar site causes local thickening of the peritoneum and the fascia, further augmenting the resistance to possible herniation of the bowel or other content of the peritoneal cavity though the port site defect. In distinction to the traditional suture-closure of the fascia, this technique is simple, quick and may result in less postoperative pain at the trocar site, since less pulling and ischemia of the fascia and the sutured muscles are present.

This technique was utilized in 300 consecutive patients undergoing Laparoscopic Sleeve Gastrectomy. It was applied at the left subcostal 15-mm trocar site opening and the left mid-abdominal 12-mm trocar site. There were no recorded postoperative hernias and no postoperative trocar site bleeding at up to 3-year follow up. The described technique may therefore be considered as an alternative for the tradisional suture closure of larger trocar site. The second part of the video is upon operating for cholecystectomy 7 month after showing well healed port-site when with no evidence of herniation,

Longer follow-up and larger case series are needed to determine the benefit of this technique and its wider application.

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