This video shows the laparoscopic post-closure technique by Dr. R.K. Mishra at World Laparoscopy Hospital, Gurgaon. Recently, a number of laparoscopic port-closure techniques have been reported to avoid the complications associated with the port closure after laparoscopic surgery. To evaluate these port-closure techniques, we compared seven new laparoscopic port-closure techniques with the standard technique of a hand-sutured closure.

Laparoscopic surgery has revolutionized modern operative practice by minimizing tissue trauma, reducing postoperative pain, shortening hospital stay, and improving cosmetic outcomes. While much emphasis is placed on the precision of intracorporeal dissection and suturing, the final step—laparoscopic port closure—is equally critical. At World Laparoscopy Hospital (WLH), meticulous attention to port closure technique reflects the institution’s commitment to patient safety, surgical excellence, and advanced minimally invasive training.

Importance of Proper Port Closure

Port sites serve as entry points for trocars ranging from 5 mm to 12 mm or larger. Inadequate closure of fascial defects, particularly in ports ≥10 mm, can lead to complications such as:

• Port-site hernia

• Bleeding from abdominal wall vessels

• Infection

• Visceral entrapment

• Poor cosmetic outcome

At WLH, surgeons are trained to treat port closure as a structured surgical step rather than a routine formality. The guiding principle is: “The surgery is not complete until the ports are safely closed.”

Principles of Port Closure at WLH

The laparoscopic port closure technique at World Laparoscopy Hospital follows standardized surgical principles:

1. Assessment of Port Size and Location

   • 5 mm ports generally require only skin closure.

   • 10–12 mm ports require fascial closure.

   • Umbilical and midline ports demand extra caution due to higher hernia risk.

2. Visualization Before Closure
   Pneumoperitoneum is partially released, and under direct vision, any bleeding or entrapment is ruled out before removing the trocar.

3. Fascial Closure Technique
   WLH surgeons commonly use:

   • Suture passer techniques

   • Port closure needles

   • J-shaped or Deschamps needles

   • Specialized closure devices when required

   The fascia is closed using delayed absorbable sutures such as Vicryl or PDS to ensure strength and long-term integrity.

4. Layer-by-Layer Closure

   • Peritoneum (if necessary)

   • Fascial sheath

   • Subcutaneous tissue (if thick)

   • Skin using absorbable sutures, staples, or subcuticular technique

Advanced Techniques Practiced at WLH

As a globally recognized center for laparoscopic and robotic training, WLH emphasizes innovative and safe closure methods:

• Port Closure Under Direct Laparoscopic Vision
  Especially in obese patients, closure under vision reduces the risk of bowel entrapment.

• Carter-Thomason Technique
  Used for secure fascial approximation in larger ports.

• Extracorporeal Knotting for Fascial Closure
  Demonstrated during hands-on training sessions.

• Use of Port Closure Devices
  For deep abdominal walls or high-risk patients.

These techniques are demonstrated in live surgeries and structured skill labs to ensure surgeons gain practical mastery.

Special Considerations

1. Obese Patients
   Thick abdominal walls increase the difficulty of fascial closure. WLH teaches long-needle guided closure techniques to prevent missed fascial defects.

2. Pediatric Patients
   Gentle handling and precise closure prevent postoperative complications.

3. Emergency Cases
   Even in urgent surgeries, port closure standards are never compromised.

Prevention of Port-Site Hernia

Port-site hernia is a preventable complication. At WLH, preventive strategies include:

• Closing all ports ≥10 mm

• Avoiding excessive port manipulation

• Ensuring complete fascial approximation

• Reducing trocar site enlargement

• Using non-bladed trocars when appropriate

Through structured training programs, surgeons learn not only the “how” but also the “why” behind each step.

Training and Skill Development at WLH

World Laparoscopy Hospital integrates port closure training into its diploma and fellowship programs. Trainees practice on:

• Endotrainers

• Animal tissue models

• Live operative cases

• Simulation-based workshops

Under expert supervision, surgeons develop precision, confidence, and consistency in performing safe port closure techniques.

Conclusion

The laparoscopic port closure technique is a small yet vital component of minimally invasive surgery. At World Laparoscopy Hospital, it is treated with the same seriousness as intracorporeal suturing or advanced dissection. By adhering to standardized protocols, using innovative devices, and emphasizing structured training, WLH ensures optimal patient safety and superior surgical outcomes.