Perfecting the dual-hemostat port-closure technique

Excerpt

Dr. Spalding and colleagues deserve congratulations for their original description of a very simple technique for port closure [2]. Basically, two hemostats are used. The first hemostat is inserted into the trocar wound to lift up one side of the wound while the second hemostat retracts the overlying subcutaneous tissue. The suture needle is driven through the abdominal fascia from outside to emerge between the splayed tips of the first hemostat. In practice, this technique is easy only if the skin incision approaches 3 cm in length and the subcutaneous fat layer is not thick. For smaller wounds, the splaying of the tips of the first hemostat would have stretched the overlying wound edge tightly. The curved needle would impinge on unyielding tissues during angling, such that it often fails to get a broad enough bite of the more deeply seated fascia and peritoneum to effect a secure closure (Fig. 1). Under such circumstances a useful trick is to drive the needle “inside-out” instead of “outside-in” as follows: …