Open Access Surgery (Apr 2016)
Preclinical study evaluating a novel trocar site closure system
Abstract
Peter A Walker,1 Shinil K Shah,1,2 Erik B Wilson11Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA; 2Michael E DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USAIntroduction: Novel trocar closure devices using subperitoneal anchor placement avoid the need for a closed loop suture, and could allow faster trocar site closure with less risk derived from less instrument penetration into the abdominal cavity while decreasing fascial ischemia and tension. We completed a series of animal experiments to compare the Carter-Thomason® suture closure device and neoClose® AnchorGuide device in order to evaluate device safety, efficacy, and ease of utilization.Methods: A porcine model was utilized where 12 mm port sites were closed with either the Carter-Thomason® device or neoClose® AnchorGuide device. Animals were sacrificed at 14 and 56 days after trocar site closure followed by macroscopic and microscopic wound examination. A second group of animals underwent video analysis to evaluate the time required for fascial closure as well as depth of needle passage into the abdomen.Results: All animals survived to the endpoints (14 and 56 days) without mortality or trocar site hernia. A trend towards decreased closure times was identified when using the neoClose® device (t=18.5±2.3 seconds) compared to closure with the Carter-Thomason® device (t=32.0±8.9 seconds) (P=0.153). A significant decrease in the depth of needle penetration was seen with the neoClose® device (t=31.22±1.45 mm) compared to closure with the Carter-Thomason device (t=51.0±3.1 mm) (P<0.001). Microscopic analysis showed subperitoneal anchor location at 56 days with minimal fibrosis (neoClose® device) compared to nearly complete suture degradation with deep intramuscular location (Carter-Thomason device).Conclusion: Novel trocar closure devices could offer decreased deployment times while improving closure safety. Initial animal studies have shown that the neoClose® device yields a durable fascial closure that is easy to adopt from a technical standpoint.Keywords: trocal closure, laparoscopy, trocar hernia, closure device
