Port-site closure: a new problem, an old device.
OBJECTIVE
Trocar-site incisional hernias and their complications are reported in 1% to 6% of patients. Such hernias are attributed to the difficulty of applying standard suturing techniques to wound closure. We report our experience with a simple device, the Deschamps ligature needle.


METHODS
The Deschamps needle has a handle and a tip (sharp or blunt), with an opening to pass suture. The blunt tip is very effective for closing trocar sites. Disposable needles are obviously sharp, but can bend on the needle holder and break in a deep small incision. The Deschamps needle is a rigid, noncutting instrument that can be forced through fascia and peritoneum (around the surgeon's fingertip) avoiding loss of pneumoperitoneum. A full-thickness closure is accomplished. We perform closure under direct vision through the scope. Tactile sense is provided by the surgeon's finger. The last trocar site is closed in the same manner without the scope.


RESULTS
We have used the Deschamps needle since 1992 in all (1400) laparoscopic procedures. We close 10-mm and 5-mm trocar sites and have not observed wound dehiscence or hernias at these sites.


CONCLUSIONS
The Deschamps needle is effective in preventing incisional hernias and wound dehiscence. It is cost-effective. Disposable, single-use devices vary in price from $30 to $75 each. The Deschamps needle is sold in Italy at approximately $35 each. Considering that it may have been in the trays of most operating rooms for years (as in our case), and the number of procedures performed, we conclude that the real cost of this instrument is almost negligible.
University of Rome, Tor Vergata Department of Surgery, Italy.
Nicola
N
Di Lorenzo
Giorgio
G
Coscarella
Francesca
F
Lirosi
Achille
A
Gaspari
D004209:Disposable Equipment / Q000191:economics; D006547:Hernia / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009339:Needles / Q000191:economics; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D016896:Treatment Outcome