995 Skin Closure in Laparoscopic Surgery – a UK Based Cross-Sectional Survey

Abstract

Introduction Effective port site closure is a major mediator of patient-reported outcome measures. Traditionally, subcuticular sutures are used to close laparoscopic trocar sites. However, this can be challenging and time-consuming to achieve an effective cosmetic outcome. Skin re-approximation using tissue adhesives, such as octylcyanoacrylate, has benefits associated with aftercare, cosmesis, time-efficiency, and wound complication rates attributed to favourable bacteriostatic properties. Despite this, there remains poor uptake of its use in clinical practice. Our aim was to gain insight into port-site closure techniques favoured by a sample of laparoscopic surgeons. Method A standardised questionnaire was developed and distributed electronically to surgeons in the United Kingdom. Questions were pertaining to closure material and technique. Data was collected prospectively and analysed using Prism GraphPad. Results 63 surgeons; including 32 consultants, 22 senior trainees, 8 junior trainees and 1 allied healthcare professional participated in the study. Regarding port sites <5mm we found; 50.79% (n=32) used subcuticular sutures, 14.28% (n=9) used glue alone, and 23.80% (n=15) used glue in combination with sutures or steri-strips. For larger port sites >5mm we found 61.90% (n=39) used subcuticular sutures, 6.34% (n=4) used glue alone and 22.22% (n=14) used subcuticular sutures and glue in combination. 9.52% (n=6) used other methods of closure such as staples and sutures in combination with steri-strips. Conclusion Despite the many benefits of skin adhesive assisted closure, its uptake remains low in clinical practice. We suggest an approach targeting improvements in awareness and education to positively impact decision making regarding methods of trocar site closure.