Fascial trocar wounds are an inevitable consequence of current minimally invasive surgical techniques and postoperative trocar site hernias complicate about 0.5% of laparoscopic surgeries. In an effort to minimize the risk of hernia formation, Dr. James Carter codesigned the Carter-Thomason Needle-Point Suture Passer to facilitate the closure of trocar site defects and first described its use in 1994. Since then, many engineers have tweaked the concept of a device specific to closing trocar fascial wounds with a goal of making the best darn mousetrap. Now, into the foray comes neoSurgical, Inc., with its version of the “mousetrap” called neoClose.
Design and functionality
NeoClose is a disposable, single-use system with 3 basic components: the AnchorGuide, the needle-tipped AutoAnchor driver shaft, and AutoAnchor suture. While the AnchorGuide is a modification of a basic molded PVC device and the AutoAnchor driver shaft is a fairly commonplace needle on a stick, neoClose’s secret is the AutoAnchor suture that combines a strand of absorbable 0 PGA (polyglycolic acid) suture fixed to an absorbable 2.5 mm x 7.5 mm PLGA (polylactic-co-glycolic acid) anchor. This anchor-based system allows the suture to be placed without an assistant and further promotes a fascia closure that may be more physiologic with less tissue bunching and necrosis.
In the OR—in my two left hands—neoClose was slick. It is so intuitive and easy to use that it really makes it difficult to justify not closing fascial defects. The one trivial snafu involved a patient with a deep, narrow umbilicus but this was easily overcome by pulling back the skin edge with an Adson forceps.