function of many port closure devices (PCD) include a needlescopic grasper, which does not require a cannula. (A). From left to right: PCD in neutral position‐grasper contained within the needle lumen, PCD with top button engaged which exposes the grasper, PCD grasps suture material, PCD with suture ready to be introduced. (B) PCD and suture is introduced under visual guidance next to the cannula. (C). With suture released within the body cavity the PCD is now introduced on the opposite side of the cannula to grasp the suture end. (D). Both suture ends are now exteriorized and can be tied to close the port site.
Port Closure Devices
Formation of a postoperative trochar site herniation is considered a serious complication in human laparoscopic patients. Therefore, it has been recommended that 10 mm or larger cannula sites should be closed in adults and 5 mm or larger in children [20]. However, herniation has been reported in port sites as small as 3 mm [21]. In veterinary patients, the true incidence of such herniations has not been elucidated, and port closure recommendations are currently lacking. It seems generally accepted that all laparoscopic port sites in small animals should be closed by sutures engaging the rectus fascia whenever possible. However, like in people [22], port sites in small animals can be difficult to close in obese animals, or with obliquely oriented port sites.
For this reason, several methods have been developed to facilitate port closure under visual guidance, before or after cannula removal [22, 23]. A number of systems have been developed to facilitate closure. Most work by introducing suture under visual guidance to ensure appropriate closure of the site (Figure 4.24).
For port closure, the suture enters and exits the abdominal wall through the cannula site skin incisions, which are often quite small. To facilitate correct suture placement, many port closure systems include a suture guide (Figure 4.25).
Figure 4.25 Many port closure systems utilize a suture guide to facilitate placing the suture through the small cannula skin incision.
References
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2 2 Herati, A.S., Atalla, M.A., Rais‐Bahrami, S. et al. (2009). A new valve‐less trocar for urologic laparoscopy: initial evaluation. J. Endourol. 23 (9): 1535–1539.
3 3 Laparoscopic, M.D. (n.d.) Laparoscopic trocars. http://www.laparoscopic.md/instruments/trocar (accessed 08 May 2014).
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7 7 Whittemore, J.C., Mitchell, A., Hyink, S., and Reed, A. (2013). Diagnostic accuracy of tissue impedance measurement interpretation for correct Veress needle placement in canine cadavers. Vet. Surg. 42 (5): 613–622.
8 8 Hyink, S., Whittemore, J.C., Mitchell, A., and Reed, A. (2013). Diagnostic accuracy of tissue impedance measurement interpretation for correct Veress needle placement in feline cadavers. Vet. Surg. 42 (5): 623–638.
9 9 Leschnik, K., Bockstahler, B., Katic, N. et al. (2018). Influence of 2 Veress needles and 4 insertion sites on Veress needle penetration depth: a comparative study in cadaveric dogs. Vet. Surg. 47 (8): 1094–1100.
10 10 Mlyncek, M., Truska, A., and Garay, J. (1994). Laparoscopy without use of the Veress needle: results in a series of 1,600 procedures. Mayo Clin. Proc. 69 (12): 1146–1148.
11 11 Woolcott, R. (1997). The safety of laparoscopy performed by direct trocar insertion and carbon dioxide insufflation under vision. Aust. N. Z. J. Obstet. Gynaecol. 37 (2): 216–219.
12 12 Hasson, H.M. (1971). A modified instrument and method for laparoscopy. Am. J. Obstet. Gynecol. 110 (6): 886–887.
13 13 Giannios, N.M., Gulani, V., Rohlck, K. et al. (2009). Left upper quadrant laparoscopic placement: effects of insertion angle and body mass index on distance to posterior peritoneum by magnetic resonance imaging. Am. J. Obstet. Gynecol. 201 (5): 522 e1–522 e5.
14 14 Gould, J.C. and Philip, A. (2011). Principles and techniques of abdominal access and physiology of pneumoperitoneum. In: ACS Surgery: Principles and Practice, 6e (eds. W.W. Souba, M.P. Fink and G.J. Jurkovic). Philadelphia: PA Decker Intellectual Properties.
15 15 Surgeons, S.F.L. (2010). Prevention and management of laparoendoscopic surgical complications: laparoscopic trocar complications. http://laparoscopy.blogs.com/prevention_management_3/2010/11/laparoscopic‐trocar‐complications.html (accessed 10 October 2020).
16 16 Fiorbianco, V., Skalicky, M., Doerner, J. et al. (2012). Right intercostal insertion of a Veress needle for laparoscopy in dogs. Vet. Surg. 41 (3): 367–373.
17 17 Fuller, J., Ashar, B.S., and Carey‐Corrado, J. (2005). Trocar‐associated injuries and fatalities: an analysis of 1399 reports to the FDA. J. Minim. Invasive Gynecol. 12 (4): 302–307.
18 18 Ahmad, G., Duffy, J.M., Phillips, K., and Watson, A. (2008). Laparoscopic entry techniques. Cochrane Database Syst. Rev. (2): CD006583.
19 19 McMahon, A.J., Baxter, J.N., and O’Dwyer, P.J. (1993). Preventing complications of laparoscopy. Br. J. Surg. 80 (12): 1593–1515.
20 20 Tonouchi, H., Ohmori, Y., Kobayashi, M. et al. (2004). Trocar site hernia. Arch. Surg. 139: 1248–1256.
21 21 Bergemann, J.L., Hibbert, M.L., Harkins, G. et al. (2001). Omental herniation through a 3‐mm umbilical trocar site: unmasking a hidden umbilical hernia. J. Laparoendosc. Adv. Surg. Tech. 11: 171–173.
22 22 Shaher, Z. (2007). Port closure techniques. Surg. Endosc. 21: 1264–1274.
23 23 Mikhail, E. and Hart, S. (2014). Laparoscopic port closure. Surg. Technol. Int. 24: 27–33.
4.3 Miscellaneous Surgical Instrumentation
Penny J. Regier and W. Alex Fox‐Alvarez
Key Points
Specimen retrieval bags allow for extraction of tissue with reduced risk of bacterial or neoplastic contamination.
Single‐use integrated suction and irrigation devices are commercially available, but separate options for resterilization are also available.
Wound protector and retractor devices are very useful for increased surgical exposure and port protection.
Specimen Retrieval Bags
Prior to the development of specimen retrieval bags, minimally invasive surgeons removed intracorporeally resected tissue through unprotected port sites and small