Grooved director aids fascial enlargement and closure

Abstract

Gallbladder retrieval following laparoscopic cholecystectomy through the umbilical or epigastric port site is at times tedious, may result in gallbladder perforation from excessive tearing forces applied to the gallbladder or from instrumental perforation while attempting to enlarge the fascia and is very "low tech" compared to the laparoscopic procedure. Port-site herniae develop when the fascia at either site is not closed adequately with sutures because of inadequate vision through the small incision and the concern for inadvertent injury to the tissues underlying the fascia. This study reports the use of a simple instrument, a spoon-shaped grooved director, to aid both the fascial enlargement and the fascial closure. The instrument has been used in more than 30 laparoscopic cholecystectomies and has been found to be simple, safe and effective for fascial enlargement and closure. This reusable instrument should be used routinely for laparoscopic cholecystectomy but offers significant advantages in the obese individual.

Figure 1.

The grooved director is viewed in cross-section (top picture) and from the top (bottom picture) showing the groove.

Figure 2.

The grooved director is being used for fascial enlargement with the scalpel being passed along the groove, and the director protects the wall of the gallbladder.

Figure 3.

The grooved director is being used for fascial closure. The needle is being placed through the fascia along the groove of the director and the underlying viscera protected by the spoon of the director.