Further modification of the dual-hemostat port closure technique

Excerpt

We read with interest the articles by Dr. Spalding et al. [2], and Dr. Ng [1] describing variations of a dual-hemostat port closure technique. We have developed a similar technique that lends itself to closure of the umbilical port, especially when it has been enlarged, to enable extraction of a large stone-laden gallbladder. Our method uses the “outside-in” technique of needle passage that Spalding et al. [2] describe, but differs in that we use a small retractor at the wound edge. The second hemostat then is used to pick up the needle from the needle holder after it has been passed through the fascial layer, as described by Ng [1]. We place our lateral ports obliquely through the abdominal wall and do not routinely close the deep fascial layer. This allows us to leave lateral ports in place and maintain the pneumoperitoneum until the umbilical port site has been closed. …