Trocar site closure with a novel anchor-based (neoClose®) system versus standard suture closure: A prospective randomized controlled trial

Objective Patients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery. Methods This is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia. Results The use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group. Conclusion Use of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up, especially in terms of long-term hernia recurrence rates.

Laparoscopic cholecystectomy: do upper GI and lower GI surgeons have similar outcomes?

Background: Laparoscopic cholecystectomy is operation performed on a regular basis, regardless of surgeon’s primary specialty. Common complications include bile duct injury, bile leaks, bleeding, and bowel injury. In Tier 2 Hospitals, upper GI surgeons will manage patients with non-complex OG and HPB disease including laparoscopic cholecystectomy. The AUGSGBI proposed that laparoscopic cholecystectomy (LC) be performed by surgeons trained in upper GI surgery. NICE guidelines recommend similarly. Concentration of surgical expertise and volumes led to lesser conversions and complications. The aim was to compare the complication rates of consecutive patients undergoing laparoscopic cholecystectomy by upper and lower GI consultants in one hospital. Methods: This was a retrospective observational study. We collected 100 consecutive patients from a list of laparoscopic cholecystectomies performed by upper GI surgeons (UGI) and lower GI (LGI) surgeons. All complications were identified from electronic patient records. Complications were recorded according to the Clavien and Dindo system. Median length of stay (LOS) was recorded and compared between the two groups. Results: There was no difference in between groups with respect to sex, age, length of stay or ASA grade, nor a significant difference in complication rates between surgeons of upper and lower GI surgeons. Conclusions: In this study in a selected group, we did not find any difference in procedure related complications between operations conducted by upper GI and lower GI surgeon groups. However, there appeared to be a higher rate of port closure related complication at the umbilicus in operations performed by the lower GI team.

Use of a novel integrated port closure system - A multi-center study

BackgroundThe incidence of port site hernia (PSH) after laparoscopic surgery can reach up to 4 %. The fascial closure at the port site can be challenging in some cases.MethodsA multi-center, prospective, open label study to evaluate a new integrated port closure system (Gordian TroClose™ 1200 by Gordian Surgical™), is presented.ResultsFifty patients were enrolled in the study. All enrolled patients underwent laparoscopic surgery, during which at least one TroClose1200 device was used per patient. Patients were followed for two and six weeks and for one year. No port PSH related to TroClose 1200 device was diagnosed at one year of follow-up. One PSH was diagnosed at a non-TroClose1200 trocar site. The surgeons were very satisfied with the new device’s performance, with an average range of 4.8-5.0 out of 5.0 usability question being above 4.80 out of 5. No severe adverse events or device related adverse events were observed.ConclusionsThe TroClose 1200 is a simple, safe and friendly device that may reduce the incidence of port site hernia.

EVALUATING PORT OPERATION DOWNTIME UNDER RCP8.5 CLIMATE CHANGE SCENARIO IN CHILEAN PORTS

The economic costs of port operation downtime due to ocean swells under the RCP8.5 climate change scenario at 8 ports in Chile is evaluated. First, wave statistics for the historical period (1985-2004) and projection (2026-2045) are computed using WWIII and 6 wind models with good performance in Southeastern Pacific Ocean (Hemer, 2016). The model is calibrated with data from directional wave buoys and satellite tracks between 1980 and 2015 in Chilean coasts (Bey et al., 2016). Offshore wave data is transferred using SWAN to point in the vicinity of each port. Then, the downtime is computed by comparing wave climate and 4 different threshold values of Hs for port closure (PPEE, 1999) for representative vessels at each site. Historical and projected downtimes are expressed in hours per year. The difference in downtime between both periods is attributed to climate change. The economic impact associated with the downtime for both periods is finally estimated.Recorded Presentation from the vICCE (YouTube Link): https://www.youtube.com/watch?v=O1e_OvWAI8E

Use of a novel integrated port closure system - A multi-center study

Background The incidence of port site hernia (PSH) after laparoscopic surgery can reach up to 4 %. The fascial closure at the port site can be challenging in some cases.Methods A multi-center, prospective, open label study to evaluate a new integrated port closure system (Gordian TroClose™ 1200 by Gordian Surgical™), is presented.Results Fifty patients were enrolled in the study. All enrolled patients underwent laparoscopic surgery, during which at least one TroClose1200 device was used per patient. Patients were followed for two and six weeks and for one year. No port PSH related to TroClose 1200 device was diagnosed at one year of follow-up. One PSH was diagnosed at a non-TroClose1200 trocar site. The surgeons were very satisfied with the new device’s performance, with an average range of 4.8-5.0 out of 5.0 usability question being above 4.80 out of 5. No severe adverse events or device related adverse events were observed.Conclusions The TroClose 1200 is a simple, safe and friendly device that may reduce the incidence of port site hernia.

The Lister AirSeal® port closure technique – Initial patient outcomes

Introduction The 12-mm AirSeal® port is widely used in robotically assisted laparoscopic prostatectomy due to its ability to maintain stable pneumoperitoneal pressures and smoke evacuation. However, it creates a potential risk of port site hernia. We have traditionally used EndoClose™ to perform full thickness closure of this port, but noted that patients experienced increased pain related to this procedure, which sometimes persisted for several months. Using the Da Vinci Si we performed peritoneal closure with 2-0 vicryl by switching the fourth arm to the right master controller. The external oblique sheath was closed outside with 1 Ethibond. Materials and methods We performed this closure in 20 consecutive patients (group 1). Postoperative day 1, 2 and post-discharge telephone consultation pain scores (1–10) were recorded and compared with the previous 20 consecutive patients who had the EndoClose closure (group 2). Results We recorded an instructional video to enable reproduction of the new technique. The mean length of stay was 1.5 days for patients in group 1 and 1.9 days for those in group 2 (P = 0.04). There was no difference in operating time or average day 1 pain scores. Post-discharge follow-up call revealed 1 of 20 patients who had AirSeal port site pain in group 1 and 5 of 17 in group 2 (P = 0.04). Pain scores also tended to be higher for group 2. Conclusions Our preliminary analysis of this novel technique to close the AirSeal port in two separate layers improves postoperative pain related to this port site.