eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
Current issue Archive Videoforum Manuscripts accepted About the journal Supplements Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank

vol. 13
Original paper

Efficacy and reliability of the use of a needle grasper to prevent trocar site hernia

Turgut Donmez, Halim Ozcevik, Oguzhan Sunamak, Dogan Yildirim

Videosurgery Miniinv 2018; 13 (4): 477–484
Online publish date: 2018/05/21
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Port site herniation is one of the serious complications of laparoscopic surgery, which decreases its benefits. Closure of a fascia defect at the port site is an important problem of laparoscopic surgery, especially in obese patients.

To evaluate needle grasper fascia closure.

Material and methods
We closed the port site fascia using a percutaneous organ-holding device (needle grasper) in laparoscopic cholecystectomy patients. This study included 334 patients who underwent laparoscopic cholecystectomy between January 2015 and January 2017 in our hospital. Patients were divided into 2 fascia closure groups: group 1 with a standard simple suturing technique and group 2 with a needle grasper to close the port site. Patient demographics, operative details, and postoperative outcomes were collected and evaluated.

There were 243 female and 91 male (total 334) patients with the mean age of 49.18 ±13.15 years. Only 1 patient in the BMI > 30 kg/m2 group of patients had port site hernia development with the needle grasper technique at the end of the 8-month follow-up period. The port site hernia incidence was higher in group 1 than group 2 (p < 0.001), but there was no significant difference in terms of operation duration between the two groups (p < 0.001, p = 0.709, respectively). In patients with a BMI > 30 kg/m2, both operation duration and port site hernia incidence were higher in simple suture closure than in the needle grasper technique (p < 0.001, p = 0.016, p = 0.005).

The needle grasper technique is easy, simple, safe, fast, and effective for fascia closure of port sites. This method can also be applied in obese patients easily, safely and in a short time.


laparoscopic cholecystectomy, needle grasper, port site hernia

Owens M, Barry M, Janjua AZ, et al. A systematic review of laparoscopic port-site hernias in gastrointestinal surgery. Surgeon 2011; 9: 218-24.
Swank HA, Mulder IM, Ia Chapelle CF, et al. Systematic review of trocar-site hernia. Br J Surg 2012; 99: 315-23.
Azurin DJ, Go LS, Arroyo LR, et al. Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 1995; 61: 718-20.
Shah PR, Naguib N, Thippeswammy K, et al. Port site closure after laparoscopic surgery. J Minim Access Surg 2010; 6: 22-3.
Hussain A, Mahmood H, Singhal T, et al. Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS 2009; 13: 346-9.
Botea F, Torzilli G, Sarbu V. A simple, effective technique for port-site closure after laparoscopy. JSLS 2011; 15: 77-80.
Tangjaroen S, Watanapa P. Unclosed fascial defect: is it the risk to develop port-site hernia after laparoscopic cholecystectomy? J Med Assoc Thai 2014; 97: 191-4.
Bergemann JL, Hibbert ML, Harkins G, et al. Omental herniation through a 3 mm umbilical trocar site: unmasking a hidden umbilical hernia. J Laparoendosc Adv Surg Tech A 2001; 11: 171-3.
Tonouchi H, Ohmori Y, Kobayashi M, et al. Trocar site hernia. Arch Surg 2004; 139: 1248-56.
Lasheen AE, Salem A, Abd Elaal S, et al. Percutaneous trans-abdominal external looped needle with two holes in the trocar sheath for port-site closures in difficult obese cases. Asian J Endosc Surg 2016; 9: 295-9.
Lasheen AE, Safwat K, Elsheweal A, et al. Effective, simple, easy procedure for laparoscopic port closure in difficult cases. Ann Med Surg 2016; 10: 36-40.
Boldo E, Perez de Lucia G, Aracil JP, et al. Trocar site hernia after laparoscopic ventral hernia repair. Surg Endosc 2007; 21: 798-800.
Plaus WJ. Laparoscopic trocar site hernias. J Laparoendosc Surg 1993; 3: 567-70.
Sanz-Lopez R, Martınez-Ramos C, Nunez-Pena JR, et al. Incisional hernias after laparoscopic vs open cholecystectomy. Surg Endosc 1999; 13: 922-4.
Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc 2001; 15: 663-6.
Nassar AH, Ashkar KA, Rashed AA, et al. Laparoscopic cholecystectomy and the umbilicus. Br J Surg 1997; 84: 630-3.
Di Lorenzo N, Coscarella G, Lirosi F, et al. Trocars and hernias: a simple, cheap remedy. Chir Ital 2005; 57: 87-90.
Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, et al. Risk of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 1997; 21: 529-33.
Fear R. Laparoscopy, a valuable aid in gynecologic diagnosis. Obstet Gynecol 1968; 31: 297.
Aziz HH. A simple technique of laparoscopic port closure. JSLS 2013; 17: 672-4.
Shaher Z. Port closure techniques. Surg Endosc 2007; 21: 1264-74.
Critchlow JT. Trocar site closure: a simple, inexpensive technique. JSLS 1997; 1: 273-5.
Chung RS. Closure of trocar wounds in laparoscopic operations. Surg Endosc 1995; 9: 534-6.
Di Lorenze N, Coscarella G, Lirosi F, et al. Port site closure: a new problem, an old device. JSLS 2002; 6: 181-3.
Rajendiran A, Maruthupandian D, Karunakaran K, et al. Aneurysm needle as an effective tool in laparoscopic port closure. J Laparoendosc Adv Surg Tech A 2015; 25: 744-6.
Hussain A, Mahmoud H, Singhal T, et al. Long term study of port site incisional hernia after laparoscopic procedures. JSLS 2009; 13: 346-9.
Hamayora HA. A simple technique of laparoscopic port closure. JSLS 2013; 17: 672-4.
Lasheen A, Safwat H, Fiad A, et al. Port-site closure using a modified aptos needle. JSLS 2013; 17: 312-5.
Ng WG. A full review of port-closure techniques. Surg Endosc 2007; 21: 1895-7.
Lambertz A, Stüben BO, Bock B, et al. Port-site incisional hernia – a case series of 54 patients. Ann Med Surg 2017; 14: 8-11.
Singal R, Zaman M, Mittal A, et al. No need of fascia closure to reduce trocar site hernia rate in laparoscopic surgery: a prospective study of 200 non-obese patients. Gastroenterology Res 2016; 9: 70-3.
Donmez T, Sunamak O, Ferahman S, et al. Two-port laparoscopic appendectomy with the help of a needle grasper: better cosmetic results and fewer trocars than conventional laparoscopic appendectomy. Videosurgery Miniinv 2016; 11: 105-10.

Received: 6.02.2018, accepted: 19.03.2018.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe