Effective peritoneal and fascial closure of abdominal trocar sites utilizing the Endo-Judge

With the increasing frequency of minimally invasive surgical procedures, we have begun to see descriptions of new and unforseen complications. One such complication is the formation of a ventral hernia through an unclosed or poorly closed fascial defect created by trocar insertion. The necessity to perform fascial closure of trocar insertion sites, particularly those greater than 5 mm, has been established and is routinely practiced by the majority of laparoscopists. Standard suture techniques can be difficult and frustrating, and often involve blind closure of the fascial defect. A number of instruments have been developed to facilitate this fascial closure. We are currently using a self-contained disposable fascial closure device (Endo-JudgeTM--Synergistic Medical Technologies, Inc., Orlando, Florida), which is quick and relatively simple to use. It enables secure fascial closure under direct vision with the pneumoperitoneum intact. Initial results reveal consistent fascial and peritoneal closure and no postoperative hernia formation.