Minimally invasive surgery has revolutionized the practice of surgery by reducing postoperative pain, hospital stay, and improving cosmetic outcomes. Laparoscopy, in particular, relies on the use of trocar ports through which instruments and the laparoscope are introduced into the abdominal cavity. While smaller ports (5 mm or less) usually do not require fascial closure, larger ports—especially those measuring 10 mm or more—carry a significant risk of port-site hernia. To minimize this complication, fascial closure of larger trocar sites is recommended. This is where fascial closure needles or laparoscopic port closure devices play a vital role.

Importance of Fascial Closure

When a trocar of 10 mm or larger is inserted, it creates a defect in the abdominal wall fascia. If this defect is not closed properly, abdominal contents, such as omentum or small bowel, may herniate through the defect, resulting in a port-site hernia. Such hernias can present with pain, swelling, obstruction, or strangulation, sometimes requiring reoperation.

Fascial closure is therefore crucial for:

Prevention of port-site hernia

Maintaining abdominal wall integrity

Reducing postoperative pain and bulging

Improving long-term surgical outcomes

Traditional Closure Methods

In the early days of laparoscopy, fascial closure was often done using conventional suturing techniques with straight or curved needles under direct or blind vision. While effective in some cases, these methods had drawbacks, including:

Difficulty in accurate needle placement

Risk of injuring intra-abdominal organs

Longer operative time

Incomplete closure, especially in obese patients

These limitations led to the development of specialized fascial closure needles and port closure devices, designed specifically for safe and efficient closure of laparoscopic port sites.

Types of Fascial Closure Needles

Several designs have been introduced, each with unique mechanisms to facilitate closure:

Veress Needle Technique
Sometimes adapted for fascial closure, though primarily designed for pneumoperitoneum creation. However, it is less commonly used now for closure.

Suture-Pass Needles (Carter-Thomason Device)
This device uses a suture-capturing system. A needle is introduced percutaneously adjacent to the port site, grasping the suture under direct laparoscopic vision, and then retrieving it to close the fascia.

Reverdin Needle
A specially designed instrument that allows passing and retrieving sutures through the fascial layer. It has a hook or eyelet mechanism to securely hold sutures during transfer.

Deschamps Needle
A curved needle with a handle, traditionally used in open surgery but sometimes adapted for port-site closure.

EndoClose™ Needle
A widely used disposable closure needle that enables percutaneous passage and retrieval of sutures under laparoscopic guidance. Its design allows secure capture of the suture and facilitates precise closure.

Suture Passer with Cannula Guidance
Some devices combine a guiding cannula with a suture passer needle to ensure proper angulation and safe entry into the fascia.

Technique of Fascial Closure Using Needles

The general steps involve:

Visualization – Under laparoscopic guidance, the fascial defect is identified.

Needle Insertion – The closure needle, armed with suture material, is introduced percutaneously near the port site.

Suture Passage – The suture is passed through the fascial edge, either directly or with the aid of a grasper inside the abdomen.

Suture Retrieval – The needle is reintroduced from the opposite side, capturing the suture and bringing it out through the abdominal wall.

Knot Tying – The suture ends are tied extracorporeally to approximate the fascial edges securely.

This technique ensures full-thickness closure of the fascial defect, minimizing the risk of port-site hernia.

Advantages of Fascial Closure Needles

Safety: Direct visualization reduces the risk of injury to intra-abdominal organs.

Efficiency: Faster and more reliable than blind suturing techniques.

Versatility: Can be used in patients with obesity or thick abdominal walls.

Reduced Complications: Minimizes risk of hernia, infection, or incomplete closure.

Clinical Considerations

When to Close: Any trocar site ≥10 mm, midline sites, and sites in children should always be closed. In obese patients, even 5 mm ports may warrant closure.

Suture Material: Non-absorbable sutures are preferred for durability, though some surgeons may use delayed absorbable sutures.

Cost and Availability: Some closure devices are reusable (like Carter-Thomason), while others are disposable (like EndoClose). Selection depends on resources and institutional preference.

Limitations and Challenges

Learning curve for surgeons unfamiliar with specialized closure needles.

Disposable devices can increase procedural cost.

Rare complications, such as inadvertent visceral or vascular injury, if used without adequate visualization.

Conclusion

Fascial closure of laparoscopic port sites is an essential step in ensuring patient safety and preventing long-term complications like port-site hernia. The use of specialized fascial closure needles—such as EndoClose, Carter-Thomason, and Reverdin—has made this process safer, quicker, and more reliable. With proper training and technique, surgeons can achieve secure closure even in challenging cases such as obese patients or large trocar sites. As laparoscopic surgery continues to expand, mastery of fascial closure techniques remains an indispensable skill for every minimally invasive surgeon.