This video demonstrates Laparoscopic Port Closure Needles explained by Dr. R K Mishra at World Laparoscopy Hospital. Fascial closure of port sites represents a challenging issue in laparoscopic surgery. We have reported a novel technique for the closure of the ports after laparoscopic surgery. Using this technique all the ports are closed under vision, thus preventing port herniation. New technical challenges have emerged since the introduction of the laparoscopic approach in surgery. One of these is fascial closure at port sites, which is necessary especially when large trocars are used or after dilation of a port site for organ extraction. New developments, such as single-port laparoscopic surgery, and the need for small esthetic incisions render fascial closure a current issue.

Minimally invasive surgery, particularly laparoscopy, has revolutionized modern surgical practice by reducing patient morbidity, shortening recovery times, and improving cosmetic outcomes. However, even in laparoscopic procedures, certain challenges remain—one of the most crucial being the closure of laparoscopic ports, especially those larger than 10 mm. Proper port closure is essential to prevent complications such as port-site hernia, infection, and bleeding. This is where fascial closure needles play a vital role.

What is Port Closure?

During laparoscopic surgery, surgeons create small incisions called ports to insert trocars, cameras, and instruments. After completing the surgery, these incisions need to be closed meticulously, particularly the fascial layer, which is the strong connective tissue underneath the skin and subcutaneous tissue. Simply closing the skin is not enough for large ports because the fascial defect can allow internal organs, especially bowel loops, to herniate, leading to a port-site hernia.

Fascial Closure Needles: An Overview

Fascial closure needles are specialized instruments designed to safely and efficiently close the fascia of laparoscopic ports. They come in various designs, each suited for specific situations:

1. Suture Passer Needles

   • Designed to pass a suture through the fascial layer from one side of the port to the other.

   • Minimizes risk of injury to internal organs.

2. Carter-Thomason CloseSure System

   • A widely used fascial closure device.

   • Allows for precise closure under direct vision or via a blind technique.

3. EndoClose™ Trocar Site Closure Device

   • Enables secure closure of 10–12 mm port sites.

   • Provides easy needle guidance, reducing technical difficulty.

4. Berci Fascia Closure Needle

   • Often used in gynecologic laparoscopy.

   • Designed for controlled suture passage through small fascial openings.

Techniques of Port Closure

1. Direct Fascial Suturing

• The simplest method involves lifting the fascial edges with a needle holder and suturing them manually.

• Requires careful attention to avoid bowel injury.

2. Needle-Passing Devices

• Specialized needles allow percutaneous passage of sutures without enlarging the port incision.

• Reduces operative time and improves safety, especially in obese patients.

3. Laparoscopic-Assisted Closure

• Closure is performed under laparoscopic vision.

• Ensures direct visualization of the needle path and reduces the risk of organ injury.

Safety Considerations

• Always ensure that the fascial closure is performed for ports ≥10 mm, as smaller ports rarely require fascial suturing.

• Avoid blindly passing needles in thin or obese patients without proper technique to prevent visceral injury.

• Use absorbable or non-absorbable sutures based on surgeon preference and patient factors.

• Inspect closure sites postoperatively for bleeding or signs of early hernia formation.

Advantages of Using Fascial Closure Needles

• Minimizes port-site hernia risk.

• Reduces operative time compared to manual fascial closure.

• Enhances safety by controlling needle passage and reducing risk of visceral or vascular injury.

• Facilitates closure in difficult patients (obese, multiple prior surgeries, or awkward port locations).

Conclusion

Laparoscopic port closure is a critical step in minimally invasive surgery, and the use of specialized fascial closure needles has made this task safer, faster, and more efficient. Surgeons must be familiar with the different types of closure devices, understand their proper use, and follow best practices to minimize complications. Proper fascial closure not only ensures patient safety but also preserves the long-term success of laparoscopic surgery.