Fascial Closure Device Research Articles

Single-Incision Laparoscopic Percutaneous Extraperitoneal Surgery for the Treatment of Incarcerated Indirect Inguinal Hernia in Children.

Background: The aim of this study was to examine the feasibility and safety of the single-incision laparoscopic percutaneous extraperitoneal surgery for the treatment of incarcerated indirect inguinal hernia in children. Methods: Seventy-five patients who presented with incarcerated indirect inguinal hernia and underwent laparoscopic surgery from January 2019 to January 2022 in Children's Hospital, Zhejiang University School of Medicine were retrospectively analyzed. The data were collected including the clinical information of the patients, perioperative details, and postoperative outcomes. Results: The median age of these patients was 21 months with a median weight of 9 kg. Among these 75 patients, the herniated contents of 73 patients were pushed back successfully with external manual pressure under the monitoring of laparoscope, then we did the hernia sac high ligation by using fascial closure device. After successful reduction, three cases developed incarcerated intestine necrosis, we enlarged the umbilical incision, dragged out the necrotic intestine, and did parallel resection and anastomosis. Only in two patients, it was difficult to push back the herniated organ; therefore, these patients were converted to traditional open surgery. The average length of postoperative hospital stay for the patients who didn't get incarcerated organ necrosis was 2 days. All patients recovered very well; there was no recurrence of the hernia and any other postoperative complications. Conclusions: Single-incision percutaneous extraperitoneal laparoscopic surgery for the treatment of incarcerated indirect inguinal hernia in children appears to be safe and feasible. Our experience shows that it is recommended to perform laparoscopic surgery for incarcerated indirect inguinal hernia in children.

Exophytic interstitial ectopic pregnancy removal: novel use of Endoloop for uterine cavity preservation

Exophytic interstitial ectopic pregnancy removal: novel use of Endoloop for uterine cavity preservation

8418 Fascial Closure Technique after Gynecologic Laparoscopic Surgery and Postoperative Pain: A Randomized Controlled Trial

<h3>Study Objective</h3> To compare postoperative pain between closing port site fascia > 10 mm via traditional direct method versus fascial closure device (FCD) in patients undergoing minimally invasive gynecologic surgery. <h3>Design</h3> Prospective, singled-blinded, randomized controlled trial. Primary outcome was pain on postoperative days (POD) 1, 2, 7, and 14. <h3>Setting</h3> Tertiary care academic affiliated hospital. <h3>Patients or Participants</h3> Patients 18 years undergoing laparoscopic or robotic gynecologic procedure with one port site > 10 mm for any indication (benign and malignant) were eligible. Patients were identified in preoperative holding and consented. 123 participants were enrolled from March 2021 to March 2022. <h3>Interventions</h3> Participants were randomized to fascial closure with FCD or traditional direct closure on the day of surgery. Postoperative pain scores were assessed using digital 100-point Visual Analog Scale. Fascial closure was timed, and narcotics utilized while admitted were converted into morphine equivalents per hour. <h3>Measurements and Main Results</h3> Descriptive statistics were run on all variables and group comparisons made using independent sample t-tests, chi-squares, or Mann Whitney U. 60 patients (48.8%) were randomized to FCD group and 63 patients (51.2%) to traditional direct closure. There was no statistical difference in pain scores between FCD (POD1: 60.27±22.90, POD2: 48.61±23.01, POD7: 33.60±24.12, POD14: 23.00±24.99) and traditional closure (POD1: 53.60±29.33, POD2: 26.94±28.59, POD7: 29.31±24.05, POD14: 18.57±24.62) groups or narcotic use in morphine equivalents per hour (1.54±1.11 vs 1.98±1.23, FCD and traditional closure, respectively). Length of fascial closure was statistically significantly lower using the FCD (<i>Mdn</i> = 77.0) compared to traditional closure (<i>Mdn</i> = 137.0), <i>p</i> = .001. <h3>Conclusion</h3> This study demonstrates no significant difference in postoperative pain scores at multiple time points or narcotic use between use of FCD versus traditional direct closure, but it does show a statistically significant lower fascial closure time using the FCD.

Does Size Matter? Opioid Use after Laparoscopy for Apical Pelvic Organ Prolapse Using an 8 mm versus 10—12 mm Accessory Port

To determine whether a change in lateral accessory port (LAP) size from 10-"?>12 mm to 8 mm among women undergoing laparoscopic native tissue pelvic organ prolapse (POP) surgery was effective at reducing opioid use after surgery. Prospective cohort of women taking part in a POP surgical registry. Tertiary academic hospital in Calgary, Canada. Women undergoing laparoscopic uterosacral ligament apical suspensions for stage ≥2 POP with either uterine preservation or concomitant hysterectomy. A total of 92 women were included during a 15-month study period from June 2020 and September 2021. Laparoscopic apical suspension using either a 10-"?>12 mm or 8 mm LAP, with the change occurring at the midpoint of the study period. Fascial defects from 10-"?>12 mm ports were closed with a fascial closure device. Perioperative care and technique were otherwise unchanged. Postoperative opioiduse was measured by mean morphine equivalent daily dose, accounting for all oral and intravenous opioids used in the first 24 hours after surgery. A total of 50 cases (54.3%) useda 10-12 mm LAP, and 42 cases (45.7%) used an 8 mm LAP. Meanmorphine equivalent daily dose after surgery with a 10-12 mm LAP was significantly higher than with an 8 mm LAP (35.3[95% confidence interval (CI) 24.9-45.6]vs 13.6 [95%CI 8.0-19.2], p <.001). The proportion of women who did not require opioids postoperatively was higher in the 8 mm group(45.2%,n=19)than the 10-12 mm group (18.0%, n=9) (crude odds ratio 3.76, 95% CI 1.47-9.66).Similarly, the proportion of women who did not fill an opioid prescription after discharge was higher in the 8 mm group (35.7%, n=15) than the 10-12 mm group (16.0%, n=8) (crude odds ratio 2.92, 95% CI 1.09-7.81). These resultsremained statistically significantafter adjustment for age, body mass index, race and ethnicity, length of procedure, and concomitant procedures performed. Compared with a 10-12 mm port, the use of an 8 mm LAP during laparoscopic native tissue apical POP surgery is associated with decreased opioid use in the first 24 hours after surgery.

Outcome of percutaneous mesh fixation in transabdominal preperitoneal groin hernia repair

Background One of the commonly performed surgical procedures in general surgical practice is groin hernia repair. Different procedures have been prescribed for hernioplasty either by open or laparoscopic approaches. Tension-free hernioplasty and obliteration of myopectineal orifices necessitate mesh insertion with different methods for its fixation. Chronic groin pain post hernioplasty (either open or laparoscopic) has been considered multifactorial and most of it has been attributed to the method of mesh fixation. Aim This study aims to evaluate the outcome of temporary percutaneous mesh fixation in transabdominal preperitoneal repair (TAPP) using a fascial closure device or straight needle suture. Patients and methods This prospective study was carried out in the Department of General Surgery Al-Hussein Hospital, Al-Azhar University, Cairo, from October 2016 to December 2017, during which 30 patients were subjected to laparoscopic TAPP hernioplasty with percutaneous mesh fixation and followed up for 1 year. A full preoperative assessment was carried out on all patients. TAPP hernioplasty with percutaneous mesh fixation was performed for all patients; postoperative follow-up was performed for detection of early and late postoperative complications. All cases were followed up for 1 year to detect late complications such as chronic pain and recurrence. Results In this study, the mean age of the patients was 39.2 years. The operative time ranged from 50 to 90 min. All patients underwent uneventful TAPP repair for groin hernia; only one patient had port site bleeding, which was properly controlled during surgery. All patients were discharged on the second postoperative day with a mean hospital stay of 1 day and allowed to resume daily activities at mean 7.5 days postoperatively. Pseudohernia developed in 10% of patients without true recurrence. Only one patient developed recurrence 6 months postoperatively. One year postoperatively, none of the patients had persistent pain and there was no other recurrence. Conclusion Temporary percutaneous mesh fixation in TAPP hernioplasty either by fascial closure device or by straight needle suture is sufficient, effective in mesh fixation and reasonable in terms of cost, enabling better availability to all patients, and yielding nearly the same recurrence rate as ordinary TAPP without permanent groin pain.

Does the Difference in Fascial Closure Technique Affect Postoperative Pain?

Study ObjectiveTo compare postoperative incisional pain on postoperative days (PODs) 1 and 14 when using a fascial closure device (FCD) versus a traditional fascial closure (TFC) of the 12-mm upper quadrant port during robotic surgery. Time required to close the incision was also compared. DesignRandomized controlled trial (Canadian Task Force classification I). SettingTwo academic affiliated hospitals, The Hospital of Central Connecticut and The University of Connecticut. PatientsWomen undergoing robotic surgery for benign indications by minimally invasive gynecologists at our institutions between November 2012 and October 2014 were enrolled in the study at their preoperative visit. InterventionsPatients were randomized to either an FCD or TFC immediately before closure of the fascial incision. Pain score using a 10-point analog pain scale was recorded on POD 1 and POD 14. Time to close the fascial incision, length of surgery, and body mass index were also recorded. Measurements and Main ResultsSixty-seven patients were enrolled, and 65 were randomized at the time of the fascial closure, whereas 2 enrolled patients converted to laparotomy. Statistical analysis demonstrated that pain scores differed by fascial closure technique. Mean pain scores on POD 1 were 3.43 ± 2.48 and 2.06 ± 2.03 for the FCD and TFC, respectively (p = .028). On POD 14 the mean pain scores were 1.97 ± 2.48 and .83 ± 1.42 for the FCD and TFC, respectively (p = .102). Times to close fascia were 106.5 ± 102.28 seconds and 141.97 ± 102.85 seconds for the FCD and TFC, respectively (p = .138). ConclusionOur study demonstrates that at POD 1 the use of the fascia closure device results in higher pain scores without a significant difference in closure time.

A modified laparoscopic ureterolithotomy by pulling ureter with Carter–Thomason fascial closure and ureter incision by broken 15th blade

To evaluate the efficacy and safety of a modified laparoscopic ureterolithotomy for the treatment of upper ureteral stones; this method involved the use of a Carter-Thomason fascial closure device, a broken 15th blade. From February 2009 to December 2012, 38 patients with unilateral upper ureteral stones were examined and classified into 2 groups: one group underwent conventional laparoscopic ureterolithotomy (n = 21) and the other group underwent modified laparoscopic ureterolithotomy (n = 17). The modified laparoscopic ureterolithotomy consisted of the use of a Carter-Thomason fascial closure to extract the black silk along with the nylon tape. The ureter incision was made with a modified instrument consisting of a needle holder with a broken 15th blade tip. Patient demographics were similar in both groups. No significant differences were detected between the conventional laparoscopic ureterolithotomy and modified laparoscopic ureterolithotomy groups with respect to operating time, estimated blood loss, and stone clearance rates. Drain-indwelling times were significantly shorter in modified laparoscopic ureterolithotomy patients than in conventional laparoscopic ureterolithotomy patients (3.2 ± 1.3 vs 4.7 ± 1.5 days). Hospital stay was significantly lesser in modified laparoscopic ureterolithotomy patients than in conventional laparoscopic ureterolithotomy patients (4.3 ± 1.2 vs 5.2 ± 1.2 days). No differences were detected in the ureteral stent indwelling time for the two groups. The use of the Carter-Thomason fascial closure facilitated ureter handling, and the use of a needle holder with a broken 15th blade tip enabled a sharp and precise ureteral incision. Our method allows early removal of the drain and thus earlier patient discharge.

Multifunctional Laparoscopic Trocar With Built-in Fascial Closure and Stabilization

Multifunctional Laparoscopic Trocar With Built-in Fascial Closure and Stabilization

Gastropexy Using the Carter-Thomason Device in Lieu of T-Fasteners in a Critically Ill, Severely Obese Patient

A gastropexy with T-fasteners can maintain gastric apposition to the abdominal wall before a mature gastrocutaneous fistula. In patients at high risk for inadvertently removing their percutaneous endoscopic gastrostomy tube, or those in whom early, unintentional removal and subsequent laparotomy would be catastrophic, the T-fasteners can act as a safety mechanism. We present a case of an obese patient, for whom a surgical gastrostomy was not practical, and the T-fastener system had inadequate length to traverse the abdominal wall. Innovatively a fascial closure device was used in a similar fashion to create an equivalent gastropexy. Obesity frequently complicates surgical and critical care, providing additional technical challenges. We must continue to be creative and innovatively utilize current equipment to deliver more effective and safer care for this unique patient population.

Percutaneous Ureteral Elevation in Laparoendoscopic Single-Site Radical Nephrectomy

To describe our technique of suture-assisted ureteral retraction during Laparoendoscopic Single-Site (LESS) radical nephrectomy. A healthy, 39-year-old woman with an incidental 5-cm enhancing left renal mass elected to undergo radical nephrectomy. A 2-cm skin incision was made in the left upper quadrant of the abdomen, and a Covidien SILS port was introduced using standard Hasson techniques. Straight and angled laparoscopic instruments were used to mobilize the kidney outside of Gerota's fascia. To place the renal vessels on stretch and facilitate hilar dissection, the ureter and lower pole attachments were encircled with a 0-Vicryl suture inserted percutaneously via a disposable fascial closure device. The kidney was bagged and removed intact. The procedure was performed without complication with a total operative time of 265 minutes. EBL was minimal at 25 mL. The patient was discharged home on postoperative day 1, and final pathology revealed stage pT1b chromophobe renal cell carcinoma with negative surgical margins. LESS radical nephrectomy is feasible in select patients. Suture-assisted retraction of the ureter and lower pole attachments using a fascial closure device facilitates safe dissection and control of the renal hilum.

Objective Analysis of the Accuracy and Efficacy of a Novel Fascial Closure Device

Abdominal fascial closure after midline laparotomy can be time-consuming and inaccurate and is a common time for needle-stick injuries. The SuturTek 360 degrees Fascial Closure Device (FCD) is designed to provide a secure fascial closure while reducing the risk of needle-stick injury. To date, the accuracy and efficacy of the fascial closure obtained with this device have never been objectively determined. Ten pigs averaging 18 kg were killed and underwent a midline laparotomy. Idealized suture locations were premarked through the fascia. The animals were then randomly assigned to either a traditional suture closure or the FCD for fascial closure. Surgeons were instructed to place sutures through the idealized markers. Surgeons were then evaluated based on the time to close fascia and distance from the markers. Abdominal bursting pressures were obtained using a manometric balloon. Accuracy was also tested on an ex vivo model on which the participants were again asked to place stitches as close as possible to idealized marks, and absolute distance from the idealized location was calculated. The FCD resulted in a faster closure time when compared with traditional closure (5.9 +/- 0.6 vs 7.7 +/- 1.0 minute, P = .012), with a similar accuracy of placement from the idealized markers (1.5 +/- 1.4 mm vs 0.8 +/- 1.1 mm). Bursting pressures were similar between the 2 groups: 470 +/- 71 mm Hg for FCD versus 453 +/- 94 mm Hg for traditional closure ( P = .76). The FCD resulted in a faster fascial closure with similar accuracy and strength when compared with traditional open techniques. The potential reduction in serious needle-stick injuries warrants prospective trials.

Aortic Puncture With a Laparoscopic Fascial Closure Device

Vascular injury during laparoscopic surgery typically occurs with the blind insertion of either the Veress needle or the trocar. We report an aortic puncture from the use of a laparoscopic fascial closure device. After a laparoscopic-assisted vaginal hysterectomy and during closure of the 10-mm umbilical port with a fascial closure device, attempted passage of the needle encountered unusual resistance in the abdominal wall. Application of increased force resulted in uncontrolled entry of the needle into the abdominal cavity and a 1-mm puncture of the aorta. After emergency laparotomy the puncture was successfully repaired by a vascular surgeon. A previously unreported complication of this laparoscopic fascial closure device is aortic injury. Unusual resistance to passage of the needle should engender extra caution. The use of assistive closure devices should be reserved for patients with difficult anatomy.

Breakage of fascial closure device during laparoscopic surgery

Breakage of instruments during laparoscopic surgery is rare. However, when it does occur, locating and retrieving the broken part of the instrument can be cumbersome. Moreover, inability to do so may carry serious medicolegal implications. We report a patient in whom the tip of a fascial closure device broke during laparoscopic surgery. This was located by intraoperative fluoroscopy and retrieved from the extraperitoneal plane via a small incision. The paper discusses the probable factors responsible for breakage of the fascial closure device in our patient and reviews the previously reported cases of the rare complication of breakage of instruments during laparoscopic surgery.

Trocar site closure: a new and easy technique.

The GORE (W.L. Gore & Associates, Phoenix, AZ) Suture Passer, a new reusable fascial closure device, is one of the best devices on the market for closure of laparoscopic trocar site wounds. The technique for closure of fascia using this device is described. It is a cost-effective, safe, and easy.

Effective peritoneal and fascial closure of abdominal trocar sites utilizing the Endo-Judge.

With the increasing frequency of minimally invasive surgical procedures, we have begun to see descriptions of new and unforseen complications. One such complication is the formation of a ventral hernia through an unclosed or poorly closed fascial defect created by trocar insertion. The necessity to perform fascial closure of trocar insertion sites, particularly those greater than 5 mm, has been established and is routinely practiced by the majority of laparoscopists. Standard suture techniques can be difficult and frustrating, and often involve blind closure of the fascial defect. A number of instruments have been developed to facilitate this fascial closure. We are currently using a self-contained disposable fascial closure device (Endo-JudgeTM--Synergistic Medical Technologies, Inc., Orlando, Florida), which is quick and relatively simple to use. It enables secure fascial closure under direct vision with the pneumoperitoneum intact. Initial results reveal consistent fascial and peritoneal closure and no postoperative hernia formation.