Octylcyanoacrylate skin closure in laparoscopy
Michael J Sebesta1, Jay T Bishoff
1Department of Urology/MCSU, Wilford Hall Medical Center, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78326, USA.
Background And Purpose:
Octylcyanoacrylate (Dermabond) is a tissue "glue" useful in closing surgical skin incisions. We compared skin octylcyanoacrylate with subcuticular skin sutures to close laparoscopic trocar sites.
Patients And Methods:
A randomized double-armed study was performed with 59 patients in whom 228 trocar sites were closed. Twenty-nine patients underwent subcuticular closure with 4-0 absorbable suture, and thirty patients received closure with octylcyanoacrylate in accordance with the recommendations of the manufacturer (Ethicon; Somerville, NJ). The number of sutures or vials of octylcyanoacrylate used, closure times, and postoperative wound problems were recorded. Wounds were assessed 2 weeks postoperatively for healing complications. Closure costs were estimated using published operating room time per hour plus the cost of octylcyanoacrylate or suture. Student's paired t-test was used for statistical analysis.
Results:
The overall mean time required for skin closure using octylcyanoacrylate and suture was 3.7 minutes and 14 minutes, respectively (P <0.00001). An average of 2.2 packets of suture were used to close all port sites in a particular patient, while closure with octylcyanoacrylate required an average of 3.4 vials per patient. Wound complications consisted of subcuticular seroma with skin separation and were equally common in the two groups. The overall average cost per closure using octylcyanoacrylate was $198 US dollars, while the cost for closure using suture was $497 US dollars (P <0.00001).
Conclusions:
Laparoscopic port-site skin closure with octylcyanoacrylate is rapid and effective. The method yields cost savings and a decrease in operative time of more than 9 minutes per case.
