A Simple, Safe and Cost-Effective Technique for Closure of Difficult Laparoscopic Port Sites

BACKGROUND

Port site herniation and Richter's type of strangulation of the bowel is a recognised complication following laparoscopic procedures.^1,2 Hand suturing of port sites can be difficult, especially in obese patients. A simple, safe, quick and costeffective technique is described.

TECHNIQUE

After removal of the port, the modified aneurysm needle (bent to a ‘J’ shape), threaded with an appropriate suture, is passed into the abdomen through the port site incision. The needle is then turned 90° and the eye is forced through the peritoneum and sheath from inside the abdomen, by pulling on the handle at an angle (Fig. 1A). The eye of the needle with the suture loop emerges. One arm of the suture loop is drawn out. The instrument (still threaded) is then drawn back into the peritoneum cavity, turned 180° and forced through the opposite side sheath, as described above. The suture is then withdrawn to free the needle (Fig. 1B). The tip is then drawn back into the peritoneal cavity and needle eased out.

Figure 1.

Diagrammatic illustration of the technique.

DISCUSSION

Various techniques have been described: some require expensive disposable instruments,³ whilst others need intraperitoneal threading of the needle, which can be time consuming and risk injury to intraperitoneal structures.⁴ Aneurysm needles are readily available and re-usable. In our hands, the needle is placed blindly, but this method can be performed under laparoscopic vision. The technique is straight-forward to learn.