Port-site closure using a modified aptos needle

Abstract

Background and objectives: Trocar-site incisional hernias are the most common complications in laparoscopic surgery. Fascial closure of port sites represents a challenging issue in laparoscopic surgery.

Methods: We describe a simple easy technique for fascial closure of port sites using a double-tip needle (Lasheen needle). This study included 100 patients who underwent laparoscopic surgery from January 2009 through August 2011 in the General Surgery Department, Zagazig University Hospital, Zagazig, Egypt. The mean follow-up period was 2 years for any wound complications at these trocar sites.

Results: The mean age of the patients was 39.5 years, and the mean time for placement of one suture was 2 minutes. No trocar-site herniation occurred with our technique during the period of follow-up. Infection developed at the trocar site in 3 patients.

Conclusion: This technique is easy, simple, safe, fast, inexpensive, and effective for fascial closure of trocar sites.

Conflict of interest statement

The authors have no conflicts of interest or financial ties to disclose.

Figures

Figure 1.

Lasheen needle. It is a curved needle; its length ranges from 10 to 15 cm. It has two sharp pointed ends and a hole at the middle of its length, through which the thread (No. 0 Vicryl) is passed.

Figure 2.

(a) (1) Skin and subcutaneous layer. (2) Fascial layer. (3) Peritoneum layer. The Lasheen needle with thread is passed through the port wound at the subcutaneous prefascial plane from one side of the wound to come out through the skin about 2 cm from the wound edge. (b) Only about two-thirds of the needle appears outside the skin. At this point, the needle direction is changed to pass by the other needle end through the abdominal fascia. (c) The needle with thread is passed through the abdominal fascial layers from both wound sides to appear from the skin on the other side of the trocar wound about 2 cm from its edge. (d) Only about two-thirds of the needle appears outside the skin from the other trocar wound side. Then, the needle direction is changed to pass by the first needle end, which is still present inside the tissue, through the subcutaneous prefascial plane on the other trocar wound side. (e) The needle with thread passes through the subcutaneous prefascial plane from the other wound side to come out from the port wound. (f) Finally, the needle with thread comes completely from the trocar wound. (g) One complete suture has been formed where one limb of suture is passed through one wound side through the prefascial plane and the abdominal fascia on both sides of the trocar wound, and the other limb of suture is passed through the other wound side at the prefascial plane to appear from the trocar wound. (h) The two strands of suture are tied through the wound to close the abdominal fascia well, and the suture knot lies directly on the anterior abdominal sheath.