Most surgeons agree that trocar tube incisions 10 mm. or greater should be closed at the fascial level. There are a great variety of methods for doing so as well as gadgets for accomplishing the task. I have currently settled on this method because it is very easy, rapid, and does not require the use of a disposable device.

The trocar tube is removed and the J-needle is inserted through the incision under endoscopic guidance. After assuring himself that the J-needle has not engaged the bowel or other intra-abdominal organ, the surgeon focuses his attention on the incision and the needle. Gentle pressure is applied to the fascia as the needle is withdrawn, angling the needle so that it catches only the fascia and none of the subcutaneous tissue or skin.

After withdrawing the needle, which has now engaged the fascia, the eye of the needle is threaded with a suture.

The threaded J-needle is then pushed back into the abdomen and rotated 180 degrees. The surgeon momentarily looks at the video screen to verify safe positioning of the needle. The rotated needle is then delivered back out of the incision, catching the other side of the fascia.

The suture is withdrawn from the needle and both ends of the suture are clamped in a hemostat.

The only thing that now remains is to remove the J-needle. It is returned to the abdomen, and carefully positioned for removal, which can be the trickiest and sometimes most frustrating part of the procedure. By applying pressure to the back side of the "J," the needle can usually be freed from the incision.

This image shows the finished suture.

Care should be taken not to tie the suture too tightly. Mass suturing of tissue can inadvertently include sensory nerves, thereby putting the patient at risk for severe neurogenic pain. One should therefore take as small bites of tissue as are necessary, and avoid strangulating the tissue when tying the sutures.