Comparison of newer laparoscopic port closure techniques in the porcine model

Obtaining a precise fascial closure of larger laparoscopic port sites presents an ongoing challenge for even the most experienced laparoscopic surgeons. To this end, we evaluated five new methods for closing laparoscopic port sites and compared these with the standard technique of a hand-sutured repair using a 0 absorbable suture in the pig. The new devices studied were the Carter-Thomason Needle-Point Suture Passer (CTNSP), the eXit Disposable Puncture Closure (EDPC) device, the Maciol suture needle (MSN) set, the Endoclose suture carrier, and a nonpropreitary technique using a long 14-gauge Angiocatheter and a looped Prolene suture. Unlike the typical clinical situation, the fascia of the pig lies extremely close to the skin; hence, the sutured closure could be routinely performed most quickly of all. Among the newer techniques, the CTNSP provided the quickest closure. The Endoclose, MSN, and 14-gauge Angiocatheter techniques required the use of an auxiliary grasper, which appeared to slow the closure. Only the EDPC provided an airtight closure in 100% of cases. Of the new techniques, the 14-gauge Angiocatheter technique was the least expensive ($3). The efficacy of these techniques in the clinical realm needs to be assessed by a randomized trial.