Improving cost-efficiency in port-site fascial closure: a novel Veress-needle technique and a comprehensive literature review

: Port-site incisional hernia (PIH) remains a clinically relevant complication of laparoscopic surgery, particularly at 10-12 mm trocar sites and in patients with obesity or other predisposing factors. Despite the large number of fascial closure methods reported, no universally accepted standard has emerged, and the cost or limited availability of dedicated devices may restrict their routine use. In this context, we evaluated the safety and feasibility of a novel Veress needle-based port-site closure technique and, in parallel, performed a structured literature review to contextualize its potential value among currently available strategies. In this prospective single-center cohort study, 15 adult patients underwent closure of 32 trocar sites using the proposed double-arc Veress technique. Intraoperative events, postoperative complications, and closure-site pain were systematically assessed. Follow-up included both clinical and ultrasonographic evaluation over 6-18 months. Concurrently, 40 port-site closure techniques were identified through a structured review and analyzed according to technical concept, clinical outcomes, and cost implications. No vascular or visceral injury, bleeding, infection, or PIH was observed in our cohort. Postoperative pain was minimal, with mean Visual Analogue Scale (VAS) scores of 2.0 on Postoperative Day (POD) 1 and 1.6 on POD 2. The literature review revealed substantial heterogeneity across techniques, with reported hernia rates ranging from 0 to 0.6% and marked variation in device complexity and economic burden. The double-arc Veress needle technique appears safe, reproducible, and cost-efficient, and may represent a pragmatic alternative for routine practice, particularly in resource-constrained settings.