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Laparoscopic Port Closure or Fascial Closure Needles

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hello friends today I am going to

demonstrate to you the various pour

closure techniques using laparoscopy it

is very important that in laparoscopy

ports should be adequately closed

because if the 10 millimeter port you

will not close it properly always you

have a risk of hernia the 10mm port not

close properly will have the incidence

of 0.5 to 2 percent hernia after surgery

within one year of time your present can

return back to you anytime with the

hernia and now you have to explain or

you may have to do it free because it is

considered as the surgical complication

so we should must close the 10

millimeter ports in laparoscopic surgery

today I am going to demonstrate you how

you will do the port closure in

laparoscopic surgery there are various

devices which is used for port Raja

needle first thing you should use a

suture that could be the prolene also or

you can even vital as well after that

you need a device the first and the most

popular device of the port closure is

called a facial closures middle

this is facial closure needle this

needle if you will see very carefully

there is a Java there and this jaw is

opening to hold the suture but the cave

should must be taken that in this jar

there is one group and the suture should

must be in this groove the future is not

in the groove you have a problem and in

those

tuition you can have the breakers of the

fish enclosure nidalee

if you type in the google the broken

facial closure middle then you have many

article published in which various

surgeons have shown that during the

surgery their facial progeny delivers

broken it was lost in the abdominal

cavity so you should be very careful

that it should be carefully you should

entangle the suture in the groove there

you suppose you have an Allen you should

use 45 centimeter suture for put closure

and after that you would put it this in

this groove here you see in the groove

if it is not in the groove suppose it is

on the base then it is risky because jaw

will remain open as we can see the jaw

is open and once it is opened

accidentally you can prick it and

accidentally it will break from here and

it will be dropped into the abdominal

cavity or lost in the muscles are very

Petronius so always we should hold it

and put this suture in this groove now

it will not be open now you can see the

joy is nicely closed after that you have

to start it for introducing so how to do

this is the suppose this is the port and

you have a change millimeter port here

this is Jenna millimeters port and here

it is now this is 10 millimeter

now you should take the needle and you

go by the side of this needle taking

care that the skin should not be taken

you should not take a skin and rest of

the layer except a skin you will prick

it like that once you will prick it

there under region with the other

telescopes should be in the another port

and the under region you will now take

this open the jaw and take the facial

closure out and leave the suture inside

as you can see the suture is now in

suture is left inside after that in you

go from other side here we'll go from

other side except skin all the layer

will be taken and you prick it and then

again under vision you will hold this

suture go and hold this suture catch it

and then slowly you will pull it out and

here both the end of the suture is out

well this which one is out then we

should take that remove the gas and take

the canola out and then you can tie the

the square knot so here simple square

knot can be tightened or you can use the

surgeon's knot also and here we can see

this user closing the port and this port

is closed so now there with no chance of

hernia again you can take another and

again you can tie the another knot and

port is completely closed once the port

is closed you will see that gas leaking

will stop and that itself is one of the

evidence that port is tightly closed so

this is the first instrument which is

used for the port Roger I am just

cutting it with the CJS so that I can

show you the other instrument so this is

we are cutting it and now the port is

open so this is the first instrument now

secondes provide

use for the port closure is this is

called a problem it is this is also a

very beautiful instrument that is called

as cobblers needles

cobblers needle is very effective and it

is more easier than the facial closure

needle

now this cobblers Moodle has handle and

there is shaft and it has a protective

cover so first you have to remove this

protective cover this protective sheets

is given so that needles should not bend

or needles should not break so it is out

and after that you can see here that it

has a beautiful like a various middle

and when I am pressing one needle comes

out when I leave this job goes in when

we pressed this job comes out and this

is just like the cobblers which is used

by the shoemakers to suture and this is

called as cobblers needle a cobra drill

is very effective way of port project

and you can use it very easily for 10 mm

port so what to do again you will take a

suture same way 45 centimeter suture and

then you will open the jaw here over the

job and then entangle the suture in the

Cobra - needle now it is holding the

suture after that you should hold the

Cobblers needle like a dart this is a

way to hold it like a dart and then

cannula should not be removed cannula

will remain there if you have removed

the camera then you have to occlude the

gas lead by putting your thumb so better

to cannula to keep it and you need one

five millimeter telescope in another

five millimeter port or if you don't

have a five millimeter put then you may

need one another 10 mm with a 10 mm

telescope and you will transfer the

telescope in the another 10 mm remember

all the port others should must be under

vision you should not do it blind and

then you hold it like a dart and then

you will break it you will not take skin

except skin all the layers should be

taken and is pricked in once it is

pricked in that InsideView will be

something like that and inside what you

will do you will just open the jar and

pull it out and we can see here that

this port rosa needle is leaving the

suture inside and coming out it is out

other side again other side you will

hold it like a dart and exactly in the

centre of the other side of the abdomen

wall you will go up like going oblique

is important so that only the muscle and

rectus and petroleum should be taken the

skin should not be taken and again you

will prick it so much it is pricked then

again you go inside open the job catch

the suture and then you will pull out

the suture suture is out once the suture

is out here also you remove the gas by

opening the valve and then take it out

and then under vision you will tie again

that surgeons not so this is a tight end

by your hand you will not use any

instrument and you can tight it and and

we can see as soon as I tied it see the

port is closed now there is no gas leak

will be there and entire port is closed

so this is a very effective technique

again you can take first time double

wrap followed by two opposite

alternating wrap that is the

consideration of surgeon's knot and

again you will tie it remember a skin

will be separately stitched or you can

use cyanoacrylate glue or you can use

the skinniest applet for the skin but

rest of the layer like that this muscle

rectus and plutonium should be used with

the four project

so this is done so this is a second

technique of closing the put that is

cobblers middle

now the third effective technique of the

closing of the forties that Jay needle

put closure device that Jane needles

poor closure device is also very

effective this is the device here this

is the J needle port to the device and

this is also made for port logics this

instrument if you will see here it has a

J separate needle and it has a hole at

the tip and there is a knob in the back

when I am rotating this knob the needle

comes out without and when I will rotate

this knob other side this needle is

disappeared

now riddle is disappeared when I am

rotating it to anti-clockwise needle is

on when I am rotating clockwise needle

is off so this is very good especially

designed port closure needle for

laparoscopic surgery now how to use this

middle I am going to demonstrate you so

here you will use again same way you

will use the long suture and I am using

here again 45 centimeter suture and this

is the suture which you will take it

after that you feed the suture in the

eye of the needle here this is the eye

of the needle and I am feeding the

suture in the eye of the needle and it

is freedom after that you just rotate

the needle to dis just hide the tip of

the needle which is hidden now now what

you do you have this port

this is generally with report and you

have to close now what you do you

introduce this port frozen Idol

completely inside that can lock and here

it goes everything together go inside

the cannula and inside after going

inside you will open the job and once

you will open this needle comes out

verse needle comes out then you will

pull it to just fix it with the

candlelight shell and after that you

will pull the cannula back so you can

see here I am putting the cannula back

and as soon as you will pull the cannula

back this itself will take a bite over

the suture and here the bite is taken

over the suture over the abnormal valve

now you will take one end of the suture

out here we have the one end of the

suture out and then you can afford it by

one artery forceps again you will push

the same needle back same little back

and then rotate it into the other

direction and again you pull it and

again other prick will be taken on the

other side here you pull it and see this

little is pricking it and another bite

is also taken and then again take the

suture out so this way you can do it to

time and then port can be easily closed

so this is also a very effective way of

port project again I will show you how

to do if you never do it just you push

the cannula in cannula in and then

rotate it through the other side this is

the other side this is the other side

and again pull the cannula out and as

soon as you pull it the bite is taken on

the other side and then another side of

suture you will take it out

this way you can close the port with

this instrument so I will show you it is

out both the side white is taken here

after that again you push it in and then

you hide the middle by rotating this

knob in the back you will hide the

needle and once the needle is hidden

there now it is hidden you can see it is

hidden then it will come in the cannula

and then cannula also together will be

taken out and after that you can tie the

knot so you can hold it and you can here

you go just title suggests not and see

here also port is closed and there is no

link so this is called a j-shaped Port

rosette needle which is manufactured by

the ohm surgical Xin India and it is

available by other company also and port

is closed and how you will know that

port is properly closed there will be no

gas leak so this is the third technique

of closing the food now the fourth

technique of closing the port you can

use the an original needle these type of

aneurysm needles are available in the

market and it is very effective for port

closure these original needle has to be

done under vision and you have to use a

blade a the BP handle and will be

handled should entangle the after wall

to lift it up and then you can take a

bite safely so how do you do this is a

suture and you will feed it into the eye

of this an original like this

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it is going and feeding into the eye of

the Anna designated after that tech

six-centimeter out and Bend into and

then you can take a simple bite like

that and it is going and in other side

you will come out under vision you

should must be careful that one of the

Ellie's forceps should lift it and then

again coming out and once it comes out

to the other side you will just remove

the other end of the suture yay

and then another little will be taken

back and it is back after that now it is

ready to tie the knot and here we go and

again similarly one suggest not first

time double wrap followed by two

opposite alternating wrap you will tie

and the port will be closed so this is

how the port closure can be read and see

here again portal closed and this is how

you will do with the aneurysm handle and

that is no needle can be used for safe

port closure after that the last

technique which is a our own technique

which is device while me in year 2003

and since then it is popular which is

called add various needle port closure

technique this is very useful and you

can use the port Roger with a very

gentle so now I will show you how

very sad report Roger you should take in

a middle part of the relational a stylet

has to be removed after that again you

take the 45 centimeter suture so I am

taking here

155 centimeter suture this is 45

centimeter suture after that field is

sujay into the eye of the various needle

so you will hold it like that and feel

the suture into the eye of the various

needle it is going into the eye of the

virus hidden through the through the

complete whole and after that it will

come back here this is on the back and

it is now ready

this is here and then what you do you

tie a knot here so you will take it and

you tie a knot simple knot will be

tightened you should keep it little

loose so it will be like your book and

you can take inspired knot and you will

tight it not so the purpose is that this

will make a loop pull and the purpose of

this there is little is to pull the loop

through the loop and then tie the close

tie the port so this is done

and this is a square knot you will tight

it after that you dream the suture dream

the tip of the suture and here these are

the two end of the sutures and we will

trim it away so this is this will be cut

which is cut and now this away and then

this is ready for a Jay put closure

instrument you see a beautiful port

other instrument what you have now and

you can use it for portraiture so this

is a fantastic instrument which can be

used for portraiture now what you do you

hide this knot first so you pull it like

that and this knot will go into that eye

of the Vanessa

here it is hidden it is hidden it is

done now what you do you take another

suture take another 45 centimeter suture

and the field that suture two centimeter

in the eye of this Vedas needle so it is

important that you feel this suture into

the eye of the various panel only two

centimeter it's not more than that and

after that you will bend it bend it and

you will hold it like a dart and then it

is hell like it dark you will hole like

a dart and then you will go from one

side again cannula will remain there

cannula will not be removed and

obliquely except a skin all the layer of

the eternal will be pricked and once it

is pricked then keep the thumb over the

larger suture larger suture and pull the

loops which are out so we can see we are

putting their loops which are out and

this various middle is out but this tip

of the suture is still inside the

abdomen here as you can see it's very

gentle is all true after that again you

other side of the abdomen wall go

without any suture just the loop of the

various needle will be prickly and then

you pull it it will make a bow side and

as soon as you make a bow shape

automatically it will entangle your this

suture and you can see very surprisingly

this loop will pull the other suture out

and both the end is out both the end is

out and then you can tie the knot so

here you see a loop is pulling the loop

and the loop of the various needle will

be pulled again I will show you this

technique how to do you will take the

suture and put the two centimeter of the

suture into the eye of the various

like this here you go and then Bend both

the suture and these both the suture and

very still you will hold like a dart and

after that in the abdominal wall you

will Canada will always be there Canada

will not be removed or if the camera is

removed you have to put a thumb because

all these portals are technique has to

be done under vision so you will prick

it on one side obliquely except skin all

the layers of the abdominal wall will be

taken and after that you take the thumb

and then pull it out and as you can see

that these various middle is out but the

main suture that a time suture is

already in so this is a beauty that it

is in now you go with the other side

except that except the skin all the

layers you'll break it and as soon as

you pull it a bow will form and this

suture loop will entangle that abdominal

inside abdominal suture and we'll take

it out and it is see it is coming out

and he's pulling this suture ouch

now both the end is out and after that

you will simply tie a square knot or

suggest not and it will be closed so

this is very little technique of that

see it is closed and very freely

technique of the port project this is

also a very effective technique and it

can be used in the cases where you want

do you don't have any other device you

can use this simple technique to tie the

port so these are the different

techniques of pore closure in the

laparoscopic surgery if you don't have

anything then simple alias for Sep can

be used to leave the rectus and take a

bite with the curved needle but

please make it showed very careful

because that technique had been reported

a lot of cases of the bowel obstruction

crystallization and entrapment of the

omentum or bobbles because at the end of

the surgery sudden gusts of the gas has

a tendency to pluck the momentum or the

bowel inside the bundle and then in

those situation it is very common that

during the blind technique of the

portraiture you can have the

complications and this should be avoided

so any of these port closure technique

you should adopt then these

complications will not happen so thank

you very much for watching this video

have a nice day

you