Minimally invasive midline surgery using a novel suturing technique for sacroscervical pexing. The umbilicus is infiltrated with marcaine solution. A stab incision is created through the umbilical plate. The Alexis wound retractor is used and placed within the abdomen. Once adequate placement is confirmed, it is tensioned to the anterior abdominal wall. A 2 centimeter incision is made through the umbilicus. The gel point single port system is used and three 10 centimeter trocars are placed through the gel. The gel point device is then fastened to the external ring of the Alexis retractor. A 5 millimeter 30 degree bariatric laparoscope is used to help avoid external collision with other instruments during surgery. A swivel tip light cord is also used. One of the main challenges with single port surgery is laparoscopic suturing. We present the MIMS method for laparoscopic suturing during single port surgery using the 2.8 millimeter Burci fascial closure device. It is placed through the anterior abdominal wall approximately two finger breaths above the pubic symphysis and can be used to help facilitate needle loading, mesh stabilization, and to allow for more accurate suture placement. The Burci fascial closure device can also be used as a suture and needle grasper. The Burci fascial closure device introduces the concept of minimally invasive midline surgery. This technique allows for laparoscopic suturing without the need for additional muscle splitting trocars. In combination with the single port device, all incisions are kept along the linea alba, thereby avoiding muscle splitting trocar placement. Intracorporeal knot tying is also made to seem effortless using the MIMS method for laparoscopic suturing. This technique allows for a perpendicular angle between grasper and suture to allow for easier intracorporeal knot tying. The MIMS method for laparoscopic suturing allows for more advanced surgical procedures, such as sacrosurgicopexy, which involves advanced suturing skills, to be more easily performed during single port surgery. As single port surgery continues to evolve with better instrumentation, the concept of minimally invasive midline surgery using micro-instruments may provide less post-operative pain and a more cosmetic post-operative outcome as compared to traditional muscle splitting laparoscopic techniques.

minimally invasive midline surgery

sacroscervical pexing

novel suturing method

MIMS method

laparoscopic suturing