Modified intradermal ‘figure-of-eight’ suture for cosmetic closure of umbilical port site incision

Background

One of the desired outcomes of any laparoscopic surgery is better cosmesis. While the recent trend seems to be towards needleless port closures, superiority of one technique over another is still being debated.¹ The umbilicus is a very common port site but the literature lacks data dedicated to its cosmetic closure. Moreover, the structural elevation of the umbilical mound/fold adds to the difficulty in accurate skin approximation without compromising the umbilical aesthetics. We have developed a simple, rapid and easily reproducible technique of umbilical port site incision closure.

Technique

Any suitable monofilament suture material may be used but we prefer Monocryl^® (Ethicon, Somerville, NJ, US). While the contralateral skin edge is ‘tented’ up with a toothed forceps, the needle pierces the subdermal tissue at the 3 o’clock position and is retrieved at the 9 o’clock position (Fig 1A). In between these two punctures, it traverses the underlying subcutaneous tissue (not the subdermal space). The same steps are repeated on the ipsilateral skin edge (Fig 1B). Both the ends are pulled caudally (Fig 1C) to attain adequate skin approximation (Fig 1D) that finishes with a secure ‘figure-of-eight’ configuration (Fig 1E).

Figure 1.

The modified intradermal ‘figure-of-eight’ suture: The ‘contralateral’ intradermal stitch (A). The ‘ipsilateral’ intradermal stitch (B). The appropriate skin approximation (C). The ‘on-table’ scar; note that the shape of the umbilical mound is regained (D). The ‘figure-of-eight’ suture configuration; note that both the thread ends need to be pulled caudally (E).

Discussion

In this method, the end result of the transversely (rather than longitudinally) configured coaptation of the skin edges tends to achieve the original anatomical elevation of the umbilical mound. Moreover, the firmly suture approximated wound edges are likely to decrease the rate of wound dehiscence. Although supplementary studies are needed, we encountered no wound complications in 1,853 patients over the last 3 years. Thus, it may be proposed as a standard technique for umbilical port closure.