Surgical Endoscopy

, Volume 21, Issue 8, pp 1264–1274 | Cite as

Port closure techniques

Review

Abstract

Background

Laparoscopic trocars do create wounds. This article aims to review and list different techniques used for closure of the fascia incision at trocar sites.

Methods

A literature search was performed for articles dealing with closure techniques. The author searched this subject in English on Medline by combining the words “trocar” and “hernia,” as well as “Deschamps” and “Reverdin.” All articles reporting techniques with their references were reviewed.

Results

The articles described many techniques in addition to classical closure using curved needles, including Grice needle, Maciol needles, Endoclose device, Carter-Thomason device, Tahoe ligature device, Endo-Judge device, eXit puncture closure device, Lowsley retractor, spinal cord needles, dual hemostat, suture carrier, Riverdin and Deschamps needles, and Gore-Tex closure device.

Conclusion

Three main groups of techniques were found with favor of extracorporeal manipulations under direct visualization. Old methods are sufficient and cost-effective.

Keywords

Carter Thomason Deschamps Endoclose Endo-Judge eXit Gore-Tex Grice Lowsley Maciol Reverdin Tahoe Trocar hernia 

References

  1. 1.
    Azurin DJ, Go LS, Arroyo LR, Kirkland ML (1995) Trocar-site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 61: 718–720PubMedGoogle Scholar
  2. 2.
    Bergemann JL, Hibbert ML, Harkins G, Narvaez J, Asato A (2001) Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia. J Laparoendosc Adv Surg Tech A 11: 171–173PubMedCrossRefGoogle Scholar
  3. 3.
    Boughey JC, Nottingham JM, Walls AC (2003) Richter’s hernia in the laparoscopic era: four case reports and review of the literature. Surg Laparosc Endosc Percutan Tech 13: 55–58PubMedCrossRefGoogle Scholar
  4. 4.
    Bowrey DJ, Blom D, Crookes PF, Bremner CG, Johansson JL, Lord RV, Hagen JA, DeMeester SR, DeMeester TR, Peters JH (2001) Risk factors and the prevalence of trocar-site herniation after laparoscopic fundoplication. Surg Endosc 15: 663–666PubMedCrossRefGoogle Scholar
  5. 5.
    Buchweitz O, Wulfing P, Kiesel L (2005) A prospective randomized trial of closing laparoscopic wounds by transcutaneous vs subcuticular suture or adhesive papertape. Surg Endosc 19: 148–151PubMedCrossRefGoogle Scholar
  6. 6.
    Chapman WH III (1999) Trocar-site closure: a new and easy technique. J Laparoendosc Adv Surg Tech A 9: 499–502PubMedGoogle Scholar
  7. 7.
    Chatzipapas IK, Hart RJ, Magos A (1999) Simple technique for rectus sheath closure after laparoscopic surgery using straight needles, with review of the literature. J Laparoendosc Adv Surg Tech A 9: 205–209PubMedGoogle Scholar
  8. 8.
    Conlon KC, Curtin J (1995) A simple technique for the closure of laparoscopic trocar wounds. J Am Coll Surg 181: 565–566PubMedGoogle Scholar
  9. 9.
    Contarini O (1994) Complication of trocar wounds. In: Meinero M, Melotti G, Mouret Ph (eds.) Laparoscopic surgery. Masson S.p.A, Milano, Italy pp 38–44Google Scholar
  10. 10.
    Di Lorenzo N, Coscarella G, Lirosi F, Gaspari A (2002) Port-site closure: a new problem, an old device JSLS 6(2): 181–3PubMedGoogle Scholar
  11. 11.
    Durkin DJ, Horner J (2005) Further modification of the dual-hemostat port closure technique. Surg Endosc 19: 1002PubMedCrossRefGoogle Scholar
  12. 12.
    Earle DB (1999) A simple and inexpensive technique for closing trocar sites and grasping sutures. J Laparoendosc Adv Surg Tech A 9: 81–85PubMedGoogle Scholar
  13. 13.
    Elashry O, Nakada SY, Stuart Wolf J, Sherburne Figenshau R, McDougall EM, Clayman RV (1996) Comparative clinical study of port-closure techniques following laparoscopic surgery. J Am Coll Surg 183: 335–344PubMedGoogle Scholar
  14. 14.
    Farina Perez LA, Zungri Telo E (2003) Closure of laparoscopic access ports using a Reverdin needle: a new use for an old instrument. Actas Urol Esp 27: 168–169PubMedCrossRefGoogle Scholar
  15. 15.
    Fasolino A, Colarieti G, Fasolino MC, Pastore E (2002) The use of Foley’s catheter and suturing to control abdominal wall haemorrhage provoked by the trochar: comparative study. Minerva Ginecol 54: 443–445PubMedGoogle Scholar
  16. 16.
    Fear R (1968) Laparoscopy, a valuable aid in gynecologic diagnosis. Obstet Gynecol 31: 297PubMedCrossRefGoogle Scholar
  17. 17.
    Hellinger MD, Larach SW, Ferrara A, Blake TB (1996) Effective peritoneal and fascial closure of abdominal trocar sites utilizing the Endo-Judge. J Laparoendosc Surg 6: 329–332PubMedGoogle Scholar
  18. 18.
    Hogdall C, Roosen JU (1987) Incarcerated hernia following laparoscopy. Acta Obstet Gynecol Scand 66: 735–736PubMedGoogle Scholar
  19. 19.
    Holzinger F, Klaiber C (2002) Trocar-site hernias: a rare but potentially dangerous complication of laparoscopic surgery. Chirurg 73: 899–904PubMedCrossRefGoogle Scholar
  20. 20.
    Jorge C, Carlos M, Alejandro W (1996). A simple and safe technique for closure of trocar wounds using a new instrument. Surg Laparosc Endosc 6: 392–393PubMedCrossRefGoogle Scholar
  21. 21.
    Kadar N, Reich H, Liu CY, Manko GF, Gimpelson R (1993) Incisional hernias after major laparoscopic gynecologic procedures. Am J Obstet Gynecol 168: 1493–1495PubMedGoogle Scholar
  22. 22.
    Krug F, Herold A, Wenk H, Bruch HP (1995) Incisional hernias after laparoscopic interventions. Chirurg 66: 419–423PubMedGoogle Scholar
  23. 23.
    Kulacoglu IH (2000) Comment. J Laparoendosc Adv Surg Tech A 10: 227–228PubMedCrossRefGoogle Scholar
  24. 24.
    Kurtz BR, Daniell JF, Spaw AT (1993) Incarcerated incisional hernia after laparoscopy: a case report. J Reprod Med 38: 643–644PubMedGoogle Scholar
  25. 25.
    Lajer H, Widecrantz S, Heisterberg L (1997) Hernias in trocar ports following abdominal laparoscopy: a review Acta Obstet Gynecol Scand 76: 389–393PubMedGoogle Scholar
  26. 26.
    Li P, Chung RS (1996) Closure of trocar wounds using a suture carrier. Surg Laparosc Endosc 6: 469–471PubMedCrossRefGoogle Scholar
  27. 27.
    Leibl BJ, Schmedt CG, Schwarz J, Kraft K, Bittner R (1999) Laparoscopic surgery complications associated with trocar tip design: review of literature and own results. J Laparoendosc Adv Surg Tech A 9: 135–140PubMedGoogle Scholar
  28. 28.
    Liu CD, McFadden DW (2000) Laparoscopic port sites do not require fascial closure when nonbladed trocars are used. Am Surg 66: 853–854PubMedGoogle Scholar
  29. 29.
    Lowry PS, Moon TD, D’Alessandro A, Nakada SY (2003) Symptomatic port-site hernia associated with a nonbladed trocar after laparoscopic live donor nephrectomy. J Endourol 17: 493–494PubMedCrossRefGoogle Scholar
  30. 30.
    Maio A, Ruchman RB (1991) CT diagnosis of postlaparoscopic hernia. J Comput Assist Tomogr 15: 1054–1055PubMedCrossRefGoogle Scholar
  31. 31.
    Majeski J, Anthony E (2002) An improved, inexpensive, quick, and easily learned technique for closure of all large abdominal trocar wounds after laparoscopic procedures. J Am Coll Surg 194: 391–393PubMedCrossRefGoogle Scholar
  32. 32.
    Matthews BD, Heniford BT, Sing RF (2001) Preperitoneal Richter hernia after a laparoscopic gastric bypass. Surg Laparosc Endosc Percutan Tech 11: 47–49PubMedCrossRefGoogle Scholar
  33. 33.
    Montz FJ, Holschneider CH, Munro MG (1994) Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists. Obstet Gynecol 84: 881–884PubMedGoogle Scholar
  34. 34.
    Munro MG, Tarnay CM (2004) The impact of trocar–cannula design and simulated operative manipulation on incisional characteristics: a randomized trial. Obstet Gynecol 103: 681–685PubMedGoogle Scholar
  35. 35.
    Nadler RB, McDougall E, Bullock AD, Ludwig MA, Brunt LM (1995) Fascial closure of laparoscopic port sites: a new technique. Urology 45: 1046–1048PubMedCrossRefGoogle Scholar
  36. 36.
    Nakada SY, McDougall EM, Gardner SM,Gonzalez G, Clayman RV (1995) Comparison of newer laparoscopic port closure techniques in the porcine model. J Endourol 9: 397–401PubMedCrossRefGoogle Scholar
  37. 37.
    Nezhat C, Nezhat F, Seidman DS, Nezhat C (1997) Incisional hernias after operative laparoscopy. J Laparoendosc Adv Surg Tech A 7: 111–115PubMedGoogle Scholar
  38. 38.
    Ng WT (2003) Perfecting the dual-hemostat port closure technique. Surg Endosc 17: 1867–1868PubMedCrossRefGoogle Scholar
  39. 39.
    Petrakis I, Sciacca V, Chalkiadakis G, Vassilakis SI, Xynos E (1999) A simple technique for trocar-site closure after laparoscopic surgery. Surg Endosc 13: 1249–1251PubMedCrossRefGoogle Scholar
  40. 40.
    Radcliffe AG (1993) Richter’s herniation of the small bowel through the trocar site following laparoscopic surgery. J Laparoendosc Surg 3: 520–522PubMedGoogle Scholar
  41. 41.
    Rastogi V, Dy V (2001) Simple technique for proper approximation and closure of peritoneal and rectus sheath defects at port site after laparoscopic surgery. J Laparoendosc Adv Surg Tech A 11: 13–16PubMedCrossRefGoogle Scholar
  42. 42.
    Reardon PR, McKinney G, Craig ES (2003) The 2-mm trocar: a safe and effective way of closing trocar sites using existing equipment. J Am Coll Surg 196: 333–336PubMedCrossRefGoogle Scholar
  43. 43.
    Spalding SC, Ponsky TA, Oristian E (2002) A new dual-hemostat technique to facilitate the closure of small laparoscopic trocar incisions. Surg Endosc 17: 164–165PubMedCrossRefGoogle Scholar
  44. 44.
    Stringer NH, Levy ES, Kezmoh MP, Walker J, Abramovitz S, Sadowski DL, Keflemariam Y (1995) New closure technique for lateral operative laparoscopic trocar sites: a report of 80 closures. Surg Endosc 9: 838–840PubMedCrossRefGoogle Scholar
  45. 45.
    Tarnay CM, Glass KB, Munro MG.( 1999) Incision characteristics associated with six laparoscopic trocar–cannula systems: a randomized, observer-blinded comparison. Obstet Gynecol 94: 89–93PubMedCrossRefGoogle Scholar
  46. 46.
    Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M (2004) Trocar site hernia. Arch Surg 139: 1248–1256PubMedCrossRefGoogle Scholar
  47. 47.
    Weiland DE, Cheung P, Heilbron MJ (1995) An inexpensive, quick, and easily learned technique for closure of abdominal trocar wounds after laparoscopy. J Am Coll Surg 180: 224–226PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of SurgeryHaddawy HospitalDeirEzzorSyria

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