Optimal closure method of five-millimeter trocar sites

Abstract 

Background

Although many surgeons use absorbable sutures for skin closure of 5-mm trocar sites, effective alternative materials exist. We compared 5-mm trocar site closures using a vicryl suture (VS), cyanoacrylate tissue adhesive (CTA), or skin tape (ST).

Methods

Patients rated wound pain and appearance at 1 and 6 weeks after surgery. Seven surgeons masked to the closure method rated wound photographs at these time points using the Hollander wound evaluation scale. Logistic regression analysis was used to evaluate the ratings of each closure group.

Results

The 137 wounds of 48 patients undergoing laparoscopic procedures were randomized among three closure method groups. Patient demographics and procedure type were similar for all groups. Long closure times (>30 seconds) was significantly higher for VS compared with CTA and ST. Patients favored VS over ST and CTA at 1 week with respect to pain and wound appearance (P = 0.04 and P = 0.02, respectively). They rated CTA closures more likely to have pain and poor wound appearance at 6 weeks (P = 0.05 and P = 0.03, respectively). Surgeons rated VS less likely (P = 0.02) and CTA more likely (P = 0.003) to show moderate to severe scar formation. Vicryl suture was less likely to have wound separation and edge inversion (P = 0.017 and P = 0.006, respectively). Cyanoacrylate tissue adhesive was more likely to yield step-off (P = 0.03), contour irregularities (P = 0.005), separation (P = 0.004), excessive distortion (P = 0.001), and edge inversion (P = 0.03).

Conclusions

Although VS closure time of 5-mm trocar sites takes longer than CTA and ST, VS scar formation and comfort is superior to CTA and ST. Cyanoacrylate tissue adhesive yields poor results with respect to both wound healing and pain.

Keywords:  Wound closure, Suture, Tissue adhesive, Trocar site, Laparoscopic wound closure