A Surgical Technique for Closure of 10 mm and Larger Laparoscopic Port Fascial Defects Using a Graham's Nerve Hook

Abstract

Background and objectives: In order to avoid potential complications from incisional hernias in patients undergoing laparoscopic or robotic procedures with 10 mm or larger ports, a surgeon closes the fascial defects using various techniques. We compared several different techniques of port site closure, which uses the open technique that can be performed with or without laparoscopic visualization. We modified the technique initially described by Dr. H. Aziz. We are introducing a new surgical technique to close the larger port site using Graham's nerve-hook. This new technique is easy to learn, replicate and implement for all body types.

Methods: We use the commonly available Graham's nerve-hook and two S-retractors to visualize the entire layers of fascia and peritoneum and to pull up both layers to close the larger port site safely and securely with 0 polyglactin absorbable suture. We illustrated this new Lee's port site closure technique with eight separate drawings in this paper.

Results: We performed 493 consecutive laparoscopic cases using this new technique. Four years follow up revealed only one incisional hernia using this technique. The patients are routinely followed in one month and six months and a year after the operation. However, not all of the patients are seen after six months unless there was a specific complaint.

Conclusion: The new port site closure technique introduced in this paper is found to be easy to learn, fast, and very cost effective due to the reusable, commonly found S-retractors and Graham's nerve hook. After four years of consistent use, this new technique was found to be safe and effective in closure of 10 mm or larger port sites.

Keywords: Graham’s nerve hook; Incisional hernias; Port fascial defects; S-retractors.