Editorial comment on Carter-Thomason subcutaneous tissue closure device for laparoscopic procedure

Sir- Regarding the above name article, I would like to offer a differing viewpoint with regard to fascial closure in situations where the 10 mm port has not been extended, e.g. in the case of the removal of the gall bladder, it is impossible to insert a fascial closure device through the side of a trocar because the skin is already stretched extremely tight around the trocar. Therefore, fascial closure requires the removal of the operative trocar and insertion as in the case of the Carter/Thomason device of a plug to prevent loss of pneumoperitoneum. With regard to the authors' objections about the predrilled angle of entry, one can easily enter the peritoneum under vision some 3 mm away from the peritoneal defect by the simple expedient of angulating the plug cephalad or caudad.