Medtronic - Advances in port site closure

The neoClose port site closure device sold by Medtronic has the potential to reduce pain and complications following laparoscopic surgery. Laparoscopic surgery provides many benefits to patients and hospitals over conventional surgery, including improved outcomes, quicker recovery and lower costs. However, these procedures may have post-operative complications, including port site herniation. Studies show that up to 6% of patients develop port site hernias, although the true prevalence is likely to be higher because many patients remain undiagnosed.

Challenges of achieving closure

Full-thickness closure of the abdominal wall is recommended to prevent port site herniation, and surgeons commonly use closed-loop sutures. This can be difficult, as the defects are often too small to be closed properly using a standard suture and needle holder. In addition, reaching the optimal tension is challenging: too much can cause ischaemia, nerve entrapment or necrosis, which can lead to herniation or chronic pain.

Repairing a port site hernia costs about €21,000, increases the patient's length of stay and resource use, and delays recovery. As such, hospitals need a more effective way to close port sites and prevent complications.

Faster and simpler port site closure

The neoClose port site closure device is a novel system that enables surgeons to close the fascia quickly, simply and consistently. It combines an anchor guide and drivers for an intuitive and simplified approach to closure. After removing the trocar, the anchor guide easily slots into the incision, minimising pneumo-peritoneum loss, and its transparency enables the surgeon to maintain a good view of the port site.

Once the anchor guide is in place, the drivers are inserted, placing two absorbable sutures connected with a poly(glycolide-co-L-lactide) tack on either side of the defect. The sutures are then tied, closing the abdominal layers in a lateral approximation manner, as the strands do not cross the incision as they do in closed-loop closure.

Computational modelling with finite element analysis shows this approach, known as Vector X closure, places up to 75% less tension on the wound site than a traditional closure. It also reduces tissue bunching, which may lessen the risk of port site complications, such as nerve entrapment and the associated pain. Over time, as the wound heals, the sutures are fully absorbed by the body.

The neoClose port site closure device isn't just easy to use, it's quick and cost-effective too. Surgeons can save over 100 seconds per port site closure compared with traditional methods, which can help to improve theatre turnover times.

New standard of care

Surgeons are enthusiastic about the potential of the neoClose port site closure device. "[It] represents nothing short of a complete paradigm shift [for port site closures]," says Dr James Greenberg, chief of gynaecology at the Brigham and Women's Faulkner Hospital in Boston, US. "The device is designed to be a superior option to the closed-loop suture standard by helping to reduce port site complications and pain [post operation]."

The neoClose port site closure device represents a step forward in providing an optimised standard of care for patients during and after laparoscopic surgery, and it joins the Medtronic portfolio of trusted minimally invasive technologies. Powered by an unwavering mission to improve lives, Medtronic works with a global network of partners to develop and distribute technologies and solutions that benefit patients and healthcare systems worldwide. As the world's largest medical technology company with a legacy of innovation, Medtronic develops therapies that improve the lives of more than two people every second.

Medtronic has a licensing agreement to distribute the neoClose port site closure device exclusively in the following countries: the UK, Ireland, Spain, Italy, Germany, France, Poland,Sweden, Norway, Finland, Austria, Switzerland, Portugal and Denmark.

Preclinical results may not correlate with clinical performance in humans.

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