Comparison of Skin Closure Methods in Laparoscopic Surgery

A Comparison of the Effectiveness of Skin Closure by Glue, Clips and Skin Sutures Methods
for Patients Undergoing Laparoscopic Surgery
By (Student’s Name)
Professor’s Name
College
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Date

ABSTRACT
Surgical practitioners are faced with challenges when deciding the best wound closure
method to be used in closing the laparoscopic port sites after the surgery, especially for child
or female. An effective method should be one that: saves time in operating room; has better
cosmetic; leads to patient satisfaction; saves time and costs of removal; cost-effective;
simple; bactericidal; painless and with less complications. All these variables must be
considered by a surgeon before settling on a particular method of wound closure. Whereas
traditional skin sutures (TSS) and metal skin clips (SC) have been commonly used before,
they have had their share of shortcomings when weighed against the above-mentioned factors
for consideration. It is upon this backdrop that the current assignment is designed to compare
sutures, clips and glue methods using in laparoscopic surgeries to determine the best method
based on the metrics indicated above. To do this, this project uses an extended literature
review to review only Randomized Control Trials studies. Thematic and content analysis is
then made using the data from these RCTs to determine the best method to be recommended
for laparoscopic surgery port site’s closure. From the review and subsequent analysis, it is
evident that whereas TSS and SC are safe and effective holding other factors constant, their
applications further need instruments; they are time consuming; create an additional staff and
cost burden for the staples/sutures removal. For this reason, glues (adhesives) is
recommended to be the ideal method for laparoscopic surgery port sites’ closure. Glue is thus
the ideal incision, which, ideally, remains simple, effective, rapid, safe, inexpensive,
cosmetic, painless and bactericidal.
Keywords: Laparoscopic surgery; wound healing; surgery; skin suture; skin staple; skin
adhesive; patient satisfaction; cosmetic appearance, surgery wound; and healing time
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Table of Contents
ABSTRACT..........................................................................................................................................2
CHAPTER 1: INTRODUCTION.........................................................................................................5
1.0 Introduction.....................................................................................................................................5
Research Question:...........................................................................................................................6
CHAPTER 2: REVIEW OF LITERATURE.........................................................................................7
Method 1: Tissue Adhesives:.............................................................................................................7
Uses, pros, and cons of tissue adhesives (glue).................................................................................8
Uses...............................................................................................................................................8
Pros:..............................................................................................................................................9
Cons:.............................................................................................................................................9
Contraindication:.........................................................................................................................10
Comparison:................................................................................................................................10
Adhesive Tapes:...............................................................................................................................11
Uses, Pros and Cons.........................................................................................................................12
Uses.............................................................................................................................................12
Cons:...........................................................................................................................................12
Method 2: Sutures:..........................................................................................................................13
Types of Suture:..........................................................................................................................14
Method 3: Clips:..............................................................................................................................18
CHAPTER THREE: METHODOLOGY............................................................................................20
Introduction.....................................................................................................................................20
Searching Techniques:.....................................................................................................................20
Subject Identification:......................................................................................................................20
Limiting the Search..........................................................................................................................21
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Literature Type:...............................................................................................................................22
Prisma Chart....................................................................................................................................23
Identification...................................................................................................................................23
Screening.........................................................................................................................................23
Eligibility..........................................................................................................................................23
Included...........................................................................................................................................23
Framework for Critique...................................................................................................................24
CHAPTER 4: STUDY FINDINGS.....................................................................................................24
Category Two: Results of Wound Cosmetic Appearance.................................................................26
Category Three: Patients’ Satisfaction Results................................................................................26
CHAPTER 5: DISCUSSION:.............................................................................................................27
CHAPTER 6: CONCLUSION............................................................................................................38
REFERENCES:......................................................................................................................................................42
APPENDICES.....................................................................................................................................53
Appendix 1:.....................................................................................................................................53
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CHAPTER 1: INTRODUCTION
1.0 Introduction
Laparoscopic surgery is a form of surgery which is minimally invasive; the surgeon uses a
key hole to assess the desired body organ (Robinson et al 2004). It is a modern surgical
method whereby operations are undertaken via small incisions (normally 0.5 to 1.5
centimeter) elsewhere in the body. Laparoscopic surgery an advantage over common, open
procedure, because both hemorrhaging and pain are decreased as a result of smaller incisions
alongside shorter recovery time (Rosen et al 2005). The use laparoscope is the key element in
this laparoscopic surgery together with a long fiber optic cable system that allows the affected
area to be viewed through a snaking cable from a distant, yet more effortlessly accessible
destination. The laparoscopic surgery entails operations within pelvic and abdominal cavities
while the keyhole surgery undertaken on chest and thoracic cavity is known as thoracoscopic
surgery. The laparoscopic surgical surgery wound closure can be done using glues, clips and
sutures (Singer et al 2004). The glue is never put in wound but on a wound (outside the
wound) whereby the surgeon pinches the skin edges together when they are dry and placing a
drop of glue on the top of the wound (Chow et al 2010). This glue has tiny threads that make
it stronger as fiberglass therefore it prevents gaping and eliminates bandaging. A suture is a
threadlike substance used by surgeons to hold tissues together following the surgery. Suturing
entails use of a needle with attached length thread. There are both absorbable and non-
absorbable sutures based on the degradeability of the materials used to make the suture by the
body. Examples of absorbable sutures are original catgut and newer synthetics polylactic
acid, polyglycolic acid, caprolactone and polydioxane. Examples of non-absorbable sutures
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are made of silk or synthetic polyester, nylon or polypropylene. Clips have “teeth’ that offer
better clamping and wound closure of skin. The clips are also easy to remove following
recovery and have less trauma and usable with existing 9mm removers and applies. They are
perfect for swiftly closing wounds as they provide maximum holding force with fewer
traumas, and remain much easier and swifter to use as opposed to traditional sutures.
This extended literature review is designed to critically review the existing literature and
compare the use of skin closure by glue, clip, and suture in laparoscopic surgery to determine
the safety as well as the efficacy of the three materials. A review of ten RCT studies is done
to compare all these wound closure substances.
In essence, a surgical incision closure method has to be economical, time saving, simple to
perform, as well as provide an optimal cosmetic outcome. Albeit sutures are frequently used
in surgery, unlimited number of reviews are available in the field which compares or even
assessment the qualities and attributes of the sutures. Over the decades, the study on critical
wound healing has culminated in the technological advamncement of staples and tissues
adhesive methods. Scientist and medical researchers have conducted studies to analyze the
different types materials used for wound closure including laser assisted tissue bonding
(Simohon, Gabay and Shpolyansky et al,,, 2015).
Research Question:
Which are the most effective wound closure methods (glue, clip, or sutures) in laparoscopic
surgery?
Aim and objectives of the study:
This study is aimed at investigating which wound closure technique is most effective during
laparoscopic surgery
Specific objectives:
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 To determine which closure technique leads to optimal cosmetic appearance and less
wound complications.
 Identifying which wound closure technique (suture, glue or clip) provide the most
patient satisfaction after laparoscopic surgery.
 Investigating which wound closure technique leads to the quickest wound healing
duration
CHAPTER 2: REVIEW OF LITERATURE
Method 1: Tissue Adhesives:
Many methods are available for wound closures like glues, clips and sutures (Ebersole and
Choudhury 2018). However, the most commonly used material is sutured(Norton and Ischy
2017). Nevertheless, new techniques have been introduced such as tissue adhesives and
adhesive paper tape. In the year 1949, a cyanoacrylate tissue adhesive was developed by a
German chemist which was utilized for the first time in 1959 by a British plastic surgeon
(Buchweitz et al. 2016). In 1998, Food and Drug Association (FDA) approved Octyl-2-
cyanoacrylate or OCA for use in wound closure. It often begins to work upon being applied
within ten seconds. The stabilizer gets neutralized by partly ionized water molecules on the
surface of the skin that eventually trigger polymerization of molecules (Antoniou et al. 2016).
The OCA, interestingly, breaking strength is almost 5-times that of monofilament nylon
sutures. The HVOCA (high-viscosity octyl-2-cyanoacrylate) is a newer formulation which is
thicker as opposed to the initial OCA (Buchweitz et al. 2016). The high-viscosity has an
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advantage of risk reduction; the adhesive is applied away from the wound, there-by
enhancing the cosmetics of the skin. Under five-ten days, the adhesive sloughs of generally as
the wound re-epithelialize (Chen et al. 2010). Premature sloughing of the adhesive could
arise from topical ointment alongside frequent wound cleansing when it is treated with OCA.
Many new reports have illustrated the OCA effectiveness of skin closure in a broad range of
clinical context as well as surgical subspecialists (Park et al. 2015). The wound has to be
evaluated before the application of the adhesive for the subcutaneous sutures placement to
reduce the tension of the wound, elimination of subcutaneous dead space as well as
maximization of skin edge eversion (Buchweitz et al. 2016).
Uses, pros, and cons of tissue adhesives (glue)
( Al-mubarak and Al-Haddab 2013)
Uses
Tissues adhesives have already been utilized for decades in both major and minor skin
closure procedures. These materials have widespread applications and indications and have
been utilized for tissue adhesion, implants fixation, cerebrospinal fluid leaks closure as well
as blood vessels’ embolization (Buchweitz et al. 2016). Besides, these materials are currently
being utilized for groin wounds, facial wounds, laparoscopic surgical wounds,
blepharoplasty, hand surgery, and lacrimal punctum closure as well as hair transplantation.
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