Evaluation of a Novel Trocar-Site Closure Device in Laparoscopic Surgery

Jeon, Youngbae; Song, Soohwa; Han, Kyoung-Won; Lee, Dong-Hyuk; Baek, Jeong‐Heum

doi:10.4293/jsls.2020.00033

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Furthermore, trocar hernia formation is influenced by advanced age, sex (with males being more susceptible than females), nutritional status, diabetes, anemia, steroid therapy, renal failure, cancer, and wound infections. The risk factors associated with surgery include prolonged operative time, excessive handling of the trocar site, the size of the trocar incision, the location of the trocar insertion (umbilical areas are more susceptible to hernias), fascial failure to close the trocar, and the location and type of the trocar tip (bladed, bladeless, or radially expanding) [10][11][12]. However, not all of these risk factors have been conclusive.…”

Section: Discussionmentioning

confidence: 99%

Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study

Şermet

2023

Cureus

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Introduction There is insufficient data regarding trocar access site hernias (TSH) in laparoscopic sleeve gastrectomy (LSG). This retrospective study aimed to identify the incidence and risk factors for hernia development in patients who did not undergo fascia repair at trocar entry sites. Materials and methods We retrospectively reviewed the records of 284 patients with morbid obesity who underwent LSG between January 2016 and December 2021. The fascia of the trocar entry site was not closed in any of the patients. Weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), comorbidities, and the occurrence of complications were recorded at one, six, 12, 18, and 24 months after surgery. Ultrasonography (USG) was performed and supplemented with computed tomography (CT) when necessary. Results All patients underwent a 24-month follow-up, during which four patients developed trocar site hernias, resulting in an overall prevalence of 1.4%. Of the total hernias, two occurred within the first 30 days. A single patient required surgical intervention for an incarcerated hernia on the 18th day. Before undergoing laparoscopic sleeve gastrectomy (LSG), the mean weight and body mass index (BMI) of the participants were 124.2 ± 16.7 kg and 43.4 ± 5.7 kg/m², respectively. After one year, the participants experienced a mean percentage of excess weight loss (EWL) of 77.1 ± 12.2% and a mean total weight loss (TWL) of 33.2 ± 6.2%. Hernia formation has been found to be associated with both type 2 diabetes (T2D) and female gender. Conclusion In laparoscopic sleeve gastrectomy (LSG), repair of the trocar port closure is not always necessary. The rates of hernia at port entry sites were similar between cases with and without fascial repair.

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Section: Discussionmentioning

confidence: 99%

Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study

Şermet

2023

Cureus

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“…"Endoclose suture device" uses a spring-loaded suture carrying mechanism and is popular in some settings due to its comparatively law cost and ese of use. Some of the recent studies have assessed the new devices, such as Carter-Thomason needle & EZ-CloseTM [19,20]. This device contains two parts, asuture passer& a pilot guide.…”

Section: Discussionmentioning

confidence: 99%

Trocar-Site Herniation (TSH) of the Small Bowel following Laparoscopy Despite Rectus Sheath Closure, Resulting in Subacute Bowel Obstruction in the Early Post-Operative Period: A Case Discussion and Review of Literature

Senadheera¹,

Jayasundara²,

Jayewardene³

2020

Obstet Gynecol Cases Rev

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Laparoscopy is becoming the gold slandered of access to the abdomen and pelvis. However, it's not without unique complications. Trocar site hernia is a rare but a serious complication which can cause diagnostic confusion, in the early post-operative period. It can be potentially life threatening with obstruction, strangulation, incarceration and finally perforation of the bowel, after a seemingly uncomplicated laparoscopy. First ever TSH, reported by "Fear in 1968". Early studies described incidence from 0.002% to 5.2%. With improved surgical techniques & new closure methods, incidence has gone down significantly. Recent study, analyzing 55,244 cases reported it to be 0.016%. We discuss a case of small bowel herniation through the "12 mm lateral port", even after aponeurotic closure with polyglactin. She presented with subacute bowel obstruction needing laparotomy. A diagnostic dilemma can arise in differentiating TSH, from "iatrogenic bowel perforation &peritonitis". This article discusses how to minimize this serious complication, different port closure methods, suture materials, using currently available evidence and recommendations. USS may be less convincing particularly in obese. Diagnosis is commonly aided by plain X-ray film. CECT has significant advantages in differentiating TSH from incarcerated small bowel & ileus. RCOG advices closure of all 7 mm or larger lateral ports & 10 mm or larger midline ports. It can be prevented with proper pre-op evaluation, appropriate port selection, good specimen retrieval techniques, and use of proper closure methods & devices. Conventional J needle, laparoscopic suturing of the rectus sheath under direct vision, port closure devices, all have their own pros & cons. Specially designed port closure devices are encouraged wherever possible, especially in obese as well as patience with other risk factors. European hernia society recommends slowly absorbable monofilament sutures. Suture materials with higher tensile strength such as PDS in comparison to polyglactin may further improve outcome.

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“…A variety of techniques may be employed to close port-site wounds. Although suturing is the conventional way to close trocar port sites and treat bleeding and herniation, trocar port-site suturing is very difficult to perform, time-consuming in people with obesity, and imprecise [11,21,39,40]. Therefore, most surgeons do not perform port-site suturing because of the difficulties encountered.…”

Section: Current Laparoscopic Port Instruments Suturing and Wound Clo...mentioning

confidence: 99%

Safety and Efficacy of Trocar Port-Site Closure Using a Biological Plug Closure in Laparoscopic Bariatric Surgery: a Prospective Study

Andraos

2022

OBES SURG

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Purpose Port-site trocar closure is a challenging procedure in laparoscopic surgeries, especially in morbidly obese patients, and complications (herniation, bleeding, pain, and nerve trapping) have potentially severe consequences. This paper provides an overview of existing techniques of suturing and closure in intra-abdominal laparoscopic surgery, outlines the complications associated with port-site closure, and presents a novel technique designed to address those problems by using a sterile absorbable gelatin sponge with strong hemostatic properties (Cutanplast® Plug). Materials and Methods In this prospective study, 83 successive obese patients undergoing laparoscopic bariatric surgery (sleeve gastrectomy, sleeve plication, gastric bypass), using a standardized skin incision for trocar insertion, had port-site closure using the Cutanplast plug procedure (n = 42) or conventional suturing techniques (n = 41). Results The incidence of early complications was lower in the Cutanplast group; no patients had infections compared with 9.8% of Controls (p = 0.055) and no bleeding, ecchymosis, erythema, or redness occurred. Late complications during 2 years of follow-up were significantly lower in the Cutanplast group (0 vs. 7 hernias, p = 0.005). Most patients in the Cutanplast group required only 1–2 procedures (78.6% vs. 58.5%, p = 0.049), whereas 41.5% of controls required 3 procedures. In total, 82 trocars were used in the Cutanplast group versus 99 in controls. The single-step Cutanplast plug technique reduced operating times compared with two-step suturing techniques. Conclusion Closure of port-site trocar incisions using Cutanplast plug is fast, efficient, with potential to reduce operating times and decrease bleeding and herniation from port-site trocars insertion, particularly in obese patients. Graphical Abstract

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Evaluation of a Novel Trocar-Site Closure Device in Laparoscopic Surgery

Cited by 6 publications

References 15 publications

Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study

Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study

Trocar-Site Herniation (TSH) of the Small Bowel following Laparoscopy Despite Rectus Sheath Closure, Resulting in Subacute Bowel Obstruction in the Early Post-Operative Period: A Case Discussion and Review of Literature

Safety and Efficacy of Trocar Port-Site Closure Using a Biological Plug Closure in Laparoscopic Bariatric Surgery: a Prospective Study

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