A new technique of fascial closure for laparoscopic incisions.

Abstract

The objective was to develop a technique and instrumentation for closure of 10-mm and larger laparoscopic incisions with a single instrument under direct laparoscopic vision, ensuring complete fascial and peritoneal closure. The Carter-Thomason Needle-Point Suture Passer functions as both a needle and a grasper, allowing for performance of laparoscopic directed fascial and peritoneal closure. It uses a 2.7-mm diameter grasping tool with a single-action jaw. The device introduces the suture through the muscle, fascia, and peritoneal layers under direct laparoscopic vision, drops the suture, picks it up at the opposite side of the opening, and is withdrawn grasping the suture. The surgeon completes the mass closure of the layers by tying the suture below the skin. Pneumoperitoneum is maintained. The closed peritoneal layer is viewed through the laparoscope, and palpation of the closure ensures that the fascial layer is completely occluded. The Carter-Thomason Needle-Point Suture Passer has been used as a single instrument for closure of 10-mm and larger incision sites in over 200 advanced laparoscopic procedures since March 1993. No incisional hernias or complications of the incisional site have occurred. This instrument and the technique have been used for ligation to control hemorrhage from a lacerated inferior epigastric vessel, with successful ligation obtained in less than 5 min. It also was used to pass suture to allow ligation of the infundibulopelvic ligament. This device provides complete and secure closure of operative incisions of 10 mm or larger, thereby reducing the risk of herniation during the postoperative recovery period.