Comparison of newer laparoscopic port closure techniques in the porcine model

Objective

To evaluate five port closure devices with the standard sutured closure in the porcine model.

Study Design

Thirty-six 10 mm laparoscopic ports were closed in the upper abdomen of two adult female domestic pigs. Each pig had 18 laparoscopic ports placed under endoscopic guidance prior to the procedure. The port-closure techniques included: Carter-Thomason Needle-Point Suture Passer, eXit Disposable Puncture Closure device, the Maciol suture needle set, the Endoclose suture carrier and a 14-gauge angiocatheter and looped Prolene suture. Each closure technique was performed six times under endoscopic control in random order by the same surgical team. The team was equally unfamiliar with each of the five new closure techniques at the time of the study. The safety, ease of use, speed of closure, tightness of closure (air leak and palpation) and cost of each closure technique was evaluated.

Results

All of the newer closure techniques were performed without any injury to the bowel or underlying viscera. Complete fascial and peritoneal closure was accomplished in each case. However, only the eXit puncture set provided a leak-proof closure in every case.

The quickest method in the pig was the standard hand-sutured close; however, unlike in most clinical situations, the fascia of the pig lies extremely close to the skin, thereby facilitating completion of a rapid and secure hand-sewn closure. Among the newer techniques, the Carter-Thomason Needle-Point Suture Passer provided the quickest closures.

Discussion

Accurate hand-sutured closures of trocar sites are complicated by the small size of the incision, the thickness of the subcutaneous tissues, and the difficulty seeing and securing the fascial layer. Suturing can be particularly difficult in obese patients where the distance from the 12 mm skin incision to the underlying fascia may be more than 2 mm. The ideal laparoscopic closure technique would be quick, safe, easy to perform, inexpensive and provide a precise fascial and peritoneal closure. One theoretical advantage of the newer laparoscopic port closure techniques over the standard hand-sewn closure is the ability to close both the facial and peritoneal layers. This technique should preclude the migration of a loop of bowel into a partially closed trocar site. In addition, in the obese patient, port closure should be easier and far more secure with the newer closure techniques.

Conclusion

Each of the five newly developed port closure techniques provided a satisfactory closure of the laparoscopic trocar site in the pig. Among the devices, the eXit puncture set and the Carter-Thomason Needle-Point Suture Passer were rated slightly higher than the other disposable and reusable devices, respectively.