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Despite numerous operative advances, today’s surgeon continues to remain perplexed while offering optimal choice for umbilical hernia repair. We propose a beginner-friendly, three-step modification of the existing hybrid technique. We prospectively studied 52 patients with medium-sized defects who, under defined criteria, underwent umbilical hernioplasty by applying the 3-step laparoscopic Intra-Peritoneal On-lay Mesh (IPOM) technique. The procedure was successfully completed in all but three patients. The mean operative time and hospitalization were 38.5 min and 19.5h, respectively. Nobody developed seroma or haematoma. Two patients had superficial umbilical wound infection that settled with conservative management. There were no major complications or deaths. With a learning curve of 5 cases, our technique was well appreciated by our postgraduate residents and fellowship trainees. Satisfactory cosmetic outcomes were obtained as assessed by a locally-devised scale. On median follow-up of 37.5 months, all patients were free of recurrence. With encouraging results, we recommend our modification for wider application. However, large-volume randomized studies are needed for its establishment and wide acceptance.

Currently, transvaginal natural orifice transluminal endoscopic surgery (NOTES), the most minimally invasive option for laparoscopic surgery, suffers various technological restraints limiting its implementation. We discuss a simple modification for vaginal access to improve the existing hybrid NOTES technique. We retrospectively studied 18 women at our rural hospital in central India, who, under defined criteria, underwent transvaginal appendicectomy using innovative strategically designed submucosal tunnels. The procedure was successfully completed in all but the first three cases. None required additional abdominal trocar or analgesia beyond the first 6 h. The mean operative and hospitalisation times were 27.5 min and 18.5 h, respectively. We had no intraoperative complications and only one patient experienced postoperative self-limiting vaginal spotting. All patients were very pleased with the cosmetic results and sexual life as assessed by locally devised scales. On regular follow-up, all were progressing well. We recommend the method presented, as it is not only feasible and safe but has the potential to improve overall results. Clearly, a larger volume randomised trial would be optimal to confirm our conclusion.

Duplication of the common bile duct (CBD) is an uncommon congenital anomaly of the extrahepatic biliary tree; less than 150 cases have been reported to date. The anomaly is characterized by the presence of two ducts—usually one main common bile duct and an accessory bile duct. We present one such case in a 7-year-old girl, where the proximal CBD divided into two separate channels for a short distance and re-united distally to open as a common channel into the second part of duodenum. The main pancreatic duct opened proximally into the medial limb of the anomalous CBD, forming an abnormal pancreatico-bile duct junction (APBDJ). According to the accepted classification, this is a Type Va CBD duplication. The patient also had cholelithiasis and calculi in the medial limb and distal common channel. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, with removal of the gallstones, followed by laparoscopic cholecystectomy. Preoperative radiological imaging, such as ERCP and magnetic resonance cholangiopancreatography (MRCP) are strongly recommended for diagnosis of this condition. Surgery may not be needed for all patients and should be tailored to suit each individual case. This case is presented for its rarity, in the hope that it will contribute to the literature coverage.

Today, massive proximal small bowel resection with diverting stoma formation is a relatively common occurrence, especially in an emergency setting. However, the resultant short bowel syndrome remains difficult to manage on various nutritional fronts and commencing total parenteral nutrition, along with plethora of its associated complications, becomes almost obligatory for these unfortunate patients. In this context, the authors describe an innovative, yet, handy method of enteral feeding through distal mucous fistula using two commonly available tubes in the ward, with the aim to maximise the usage of the available gut and to outwit the ensuing need of parenteral supplementation, and name it the Jategaonkar technique. Backed with successful experience of 18 cases, it is especially useful in low-income countries and can be mastered readily even by junior doctors, paramedic staff, and stoma therapists or by patient's kin, alike. Such a procedure is yet to be reported in the available literature.

Nowadays, the acquisition of safe, effective yet rapid and minimally invasive suturing skills has become not only desirable but also an essential part of any laparoscopic intervention. Although there remains a substantial body of literature focusing mainly on varied minimal access knotting techniques, there seem to be scarcely any contributions devoted specifically to the crux of its successful execution—the precise intracorporeal needle loading methodology that eventually translates into easy and secure tissue approximation. In that context, traditional and generally accepted teaching endorses grasping of the needle at a right angle to its holder-shaft. However, after accumulating over 15 years of experience in this field, we have consistently observed this angle to be barely user-friendly; on the contrary, it is ergonomically much rate-limiting and annoying particularly in areas with limited accessibility for laparoscopic instruments. To counter these limitations, we have devised a simple technique that ensures gripping the needle in a peculiar way by the needle driver to procure an obtuse needle-to-shaft angle; this tends to make endoscopic suturing rather effortless, faster and easy to learn.

Despite its established competency, laparoscopic colorectal surgery is underutilized, even today. This is primarily attributed to the lack of structured training and the resultant steep learning curve. Moreover, these surgical interventions are frequently complicated by potentially life-threatening ureteric injuries ranging from an alarming 5-15%. To avert this, the essential pragmatic step is to access the “holy” avascular mesocolon/retroperitoneum interface accurately and protect the ureter as quickly and convincingly as possible. However, this tends to be easier said than done. Recent literature illustrates numerous methods focusing exclusively on perioperative localization of the ureter. However, such methods plausibly lack simplicity, accessibility and cost-effectiveness. Herein, we describe a particular way of dissecting around the inferior mesenteric artery that aims to identify and safeguard the left ureter very early in the course of mesocolic mobilization. We call this the “psoas myovascular window” technique. Having applied this technique on 82 consecutive occasions, we have consistently observed its precision, rapidity and ability to reduce the operative time (by avoiding random search of the ureter). It potentially allows surgeons to acquire the desired proficiency and self-confidence reasonably early on at their learning curves. To our knowledge, such a technique has yet to be reported in the literature.

Intramuscular injection is a common procedure performed in healthcare settings. Improper technique of injection could expose patient to severe complications. I would like to present a case of secondary gluteal abscess as differential diagnosis of back pain resulting from administration of intramuscular injections on dorsogluteal region. The abscess triggered unresolved high grade fever and severe backache which was not relieved by any painkiller medications. The gluteal mass was red, warm and tender on palpation. Blood test showed elevated white blood cell count. Needle aspiration was done on gluteal abscess and the specimen was sent for culture and sensitivity test. Then, the patient was treated with the most sensitive antibiotic after the result of culture and sensitivity test. Hence, greater awareness on sterile practice of intramuscular injection should be instilled among healthcare workers to minimize this complication.

Dorsal lithotomy is a commonly used position in many gastrointestinal and gynaecological laparoscopic surgeries, either in the classical or modified way. However, the available data seems to have fallen short of detailing the precise mode of its usage. In order to gain maximum advantage with minimum annoying sequel, we describe certain simple revisions of a modified lithotomy position. Over the last decade of our surgical practice, we have found these adaptations to be both technically and physiologically beneficial in many ways. Accordingly, it has been utilized in over 2000 cases without facing any complications. Hence, we strongly recommend it for frequent use. Such a technique has not been described in the literature to date.

Even today, despite brisk and enormous developments in the field of minimally invasive technology and optics, surgeons continue to face the perioperative problem of recurrent fogging and smearing of the laparoscopic lens - a source of considerable frustration. It adversely affects the efficacy of the ongoing operation and also adds to the cost. Most of the countermeasures described in the recent literature either lack procedural simplicity or steady favourable results. In this regard, we describe an intracorporeal, easy-to-use technique for regaining clear and undisturbed laparoscopic vision without the need for any specialized equipment or solutions. We have used this technique in over 4500 cases with no complications and hence recommend it for routine use.

Strategic trocar placement remains an essential component of safe laparoscopy and is responsible for almost half of the complications related to minimally invasive surgical interventions. The surgeon usually prefers to use the dominant hand to achieve the desired porting precision and comfort even for ancillary trocars. However, this tends to limit the operator’s dexterity in introducing laparoscopic ports, particularly for contralateral abdominal quadrants, and coerces him/her to undertake a number of insecure and haphazard manoeuvres towards its completion. Furthermore, in contrast to primary trocar placement, there is hardly any dedicated research available pertaining to secondary trocar insertion. We describe a simple technique of securing ancillary port using the surgeon’s nondominant hand in a systematic and controlled manner. It is an ergonomically comfortable practice wherein the operator does not need to shuffle his/her position. Having utilized this method on over 5000 occasions without any complication, we propose its wider usage by minimal access surgeons. To our knowledge, such a technique has yet to be described in the literature.

As is well-known, the term gossypiboma refers to a surgical sponge inadvertently left in the human body during surgery. Unfortunately, despite stringent perioperative guidelines, its incidence is reportedly rising. It not only makes the operating surgeon pitiably defenceless in the court-of-law, but also renders the very patient vulnerable to significant morbidity/mortality. Clinically, gossypiboma may present as an acute exudative or chronic fibrosing variety leading to bowel-wall erosion/obstruction. In this paper, we describe the unique case of a young lady who presented to us with acute small bowel obstruction secondary to an intraluminal jejunal gossypiboma. What surprised us “on table” was her clinical silence for almost three years post index surgery (mini-cholecystectomy) and, more so, the apparent absence of any tell-tale signs of mural invasion. Thus, this paper aims to make surgeons aware of such rare but medico-legally significant plausibility. To our knowledge, such a case is yet to be reported.

Nowadays, laparoscopic cholecystectomy for gallstone disease is considered not only the gold standard but an essential component of surgical training. In this regard, liver retraction plays an important role during cholecystectomy and also after specimen extraction. We describe a simple technique for liver retraction that achieves rapid, safe and steady exposure of the cystic fossa along with the subhepatic region for tackling any inadvertent bile leaks or bleeding. It is especially useful for diseased livers which are otherwise prone to iatrogenic laceration during haphazard and uncontrolled hepatic manipulation. Nonetheless, it may be easily mastered by surgical trainees, and thus reduce their learning curve.

Up to 50% of complications at a laparoscopic procedure occur at port insertion. Thus, safe and strategic port placement remains the key to obtaining acceptable results at laparoscopy. While several methods have been discussed in the literature, none have been seen as a benchmark. In this paper, we describe a simple method of laparoscopic port introduction that follows a path resembling the English letter’ Z’. We have found this technique to be advantageous in many ways. Apart from being safe and effective, it is easy to learn and ergonomically advantageous with the potential to minimize the incidence of port-site herniation. We have used it successfully on 7500 occasions over the past seven years without any short/long-term complications. Hence, it could be recommended for routine use. Such a method is yet to be reported.

Cooperative laparoscopic endoscopic intra-gastric surgery, with its ability to acquire advantages of both these technologies, is a recent development in the field of minimally invasive surgery. However, the pre-requisition of its multi-disciplinary approach together with several technical constraints have, plausibly, limited its widespread acceptance. The ever-increasing number of modifications being reported in today's literature largely underscores the inability of any one to be the best. We illustrate a novel, simple-to-learn, rapid and potentially cost-effective technique of intra-gastric surgery using just the routine laparoscopic instruments, and name it the 'Jategaonkar technique'. We have practised it in seven consecutive patients without any complications; and hence, recommend it for regular application. Such a method is yet to be described in the literature.

An unambiguous identification of anterior rectus sheath (ARS) is a crucial initial step required for precise umbilical porting in order to achieve successful execution of laparoscopic totally extra-peritoneal (TEP) hernioplasty. However, it is scarcely discussed in the present-day literature. Backed with the experience of 1100 cases, we present an easy and rapid technique of exposing the anterior rectus sheath with the aim to save operative time without compromising the safety. Such a method is yet to be described in the literature.

Roux-en-Y hepaticojejunostomy stricture is a substantial problem that develops in 10%-30% of patients and requires frequent intervention. Although endoscopic/percutaneous approaches are preferred, especially for refractory stricture, open surgical reconstruction remains the gold standard. However, such an operation may be highly challenging. The recently developed covered, self-expanding metallic stent is a useful option for such difficult cases. We present a case of recurrent Roux-en-Y hepaticojejunostomy stricture complicated by densely packed intrahepatic stones and suppurative cholangitis with failed percutaneous biliary draining. Enteroscopic manipulations were unfeasible, and the case was successfully managed by the laparoendoscopic approach. If treating surgeons have the necessary expertise, this technique may be considered in such difficult scenarios.

Pilomatricoma is a rare and mostly benign tumour arising from the hair follicles, generally located in the head and neck region and less frequently on the trunk. It may be clinically confused with rather commonly occurring pathologies like sebaceous cyst, pyogenic granuloma or even malignancy. Thus, the first and foremost step towards its management is to arrive at a convincing diagnosis, and the next is to aim at its complete excision to prevent local recurrence. In this paper, we present an unusual case of an ulcerated pilomatricoma of the chest wall in an adult male. Although its gross appearance deceptively pointed towards a malignant cause, to our surprise, it ultimately proved to be benign on histological examination. Therefore, the crux of this report is to encourage the present-day surgeon to consider pilomatricoma as an important differential before undertaking any “step-of-no-return” like an avoidable radical excision and its attending morbidity. To our knowledge, such a case has not been reported in the available literature.

Benign esophageal tumors are rare conditions. Traditionally, thoracotomy was the preferred route to approach these lesions. Now, increasingly more surgeons are using minimally invasive techniques to treat these benign mid-esophageal lesions. We present our experiences from a specialised minimally invasive surgery unit. We have managed 12 patients with benign tumors of the mid-esophagus from 1995 to 2007 in our institute. The enucleation was achieved with the patient placed in the prone position and approached via a right thoracoscopy in all cases. Hospital stay was 3–5days and there were minor postoperative complications in 2 patients. Mortality was nil. There were 10 patients with leiomyoma and 2 with GISTs, as proved by immunohistochemistry. Short and long-term follow up was satisfactory, with none of the patients having recurrences or other problems. Leiomyomas and GISTs, respectively, are the commonest benign tumors of the esophagus. Tumors more than 5cm have to be enucleated, and thoracotomy has been the traditional approach to these lesions. Thoracoscopy has definite benefits regarding reduced morbidity. The combined modality of peroperative endoscopy is useful in locating the lesion as well as confirming its complete removal. Based on our experience, a right thorax approach and the prone patient position is the ideal for thoracoscopic procedures.

The authors describe a case of a 35-year-old female with a 15-month history of progressive dysphagia. It was based on preoperative oesophagogram and oesophagogastroduodenoscopy, but their preoperative diagnosis was wrong. The authors discuss the possibilities of diagnostic challenges. Α wrong preoperative diagnostic approach was ascertained during laparoscopy, where the patient was scheduled for laparoscopic Heller’s cardiomyotomy.

Introduction The so called "Sigmoid Oesophagus" is characterized by a massively dilated, elongated and tortuous oesophagus with axial deviation that resembles sigmoid colon. The tortuous configuration and the axial deviation of oesophagus may create difficulties in performing cardiomyotomy during Heller’s operation and lead to failed surgery.

Purpose. This prospective observational study compares an innovative approach of Single-Site Multi-Port Per-umbilical Laparoscopic Endo-surgery (SSMPPLE) cholecystectomy with the gold standard—Conventional Multi-port Laparoscopic Cholecystectomy (CMLC)—to assess the feasibility and efficacy of the former.Methods. In all, 646 patients were studied. SSMPPLE cholecystectomy utilized three ports inserted through three independent mini-incisions at the umbilicus. Only the day-to-day rigid laparoscopic instruments were used in all cases. The SSMPPLE cholecystectomy group had 320 patients and the CMLC group had 326 patients. The outcomes were statistically compared.Results. SSMPPLE cholecystectomy had average operative time of 43.8 min and blood loss of 9.4 mL. Their duration of hospitalization was 1.3 days (range, 1–5). Six patients (1.9%) of this group were converted to CMLC. Eleven patients had controlled gallbladder perforations at dissection. The Visual Analogue Scores for pain on postoperative days 0 and 7, the operative time, and the scar grades were significantly better for SSMPPLE than CMLC. However, umbilical sepsis and seroma outcomes were similar. We had no bile-duct injuries or port-site hernias in this study.Conclusion. SSMPPLE cholecystectomy approach complies with the principles of laparoscopic triangulation; it seems feasible and safe method of minimally invasive cholecystectomy. Overall, it has a potential to emerge as an economically viable alternative to single-port surgery.

Background: Laparoscopic appendectomy (LA) is widely used and generally an accepted method for managing appendicitis. And the recent invention of laparoscopic trans-umbilical-appendectomy is a further improvement of LA. However, it requires expensive instruments with the requisite expertise. We discuss a useful modification of trans-umbilical appendectomy for acute appendicitis using routine instruments. Materials and Methods : From August 2009 to March 2011, 164 patients were operated by this method at our rural center. Out of them, 102 were males and 62, females. Mean age for males was 27.5 years (range, 14-51) and females, 31.2 years (range, 17-48). Mean body mass index was 21.7 kg/m 2 (range, 16.2-29) and 23.2 kg/m 2 (range, 17.4-30) for males and females respectively. Acute appendicitis patients wherein surgery was deemed essential were offered this technique. Three umbilical ports (one 10 mm and two 5 mm) were strategically placed to dissect out appendix. Routine laparoscopic instruments were used for all. Results: Mean operativetime was 45 min (range, 30-90) with 1.8% conversion-rate to conventional laparoscopy. Average blood-loss was 15 ml (range, 10-25). We had one caecal electrosurgical injury, which was managed expectantly. Umbilical sepsis and seroma were 3% and 6.1% respectively. Patients were discharged after an average 1.3 days (range, 1-4). The scars had receded in the umbilicus giving a near-scarless abdomen. Discussion: Recently developed technique of single-port appendectomy has primarily been used for chronic appendicitis. Moreover, >1 inch incision inducted per-umbilicum rises the attendant morbidity. We study a surgeon-friendly simple technique applied to acute appendicitis. Conclusion: Method described here is feasible and safe for managing acute appendicitis. It can be learnt rather easily (learning curve of 15 cases) by a laparoscopic surgeon and avoids expensive instrumentation. Thus, it may stand out in providing benefits of modern surgery to population of developing countries. Key words: Acute appendicitis, Laparoscopic appendectomy, Trans-umbilical surgery

Umbilical single-port surgery is a recent development that produces better cosmesis and lesser pain. However, the steep learning curve and the higher surgical expense have led to its rather sceptical acceptance. In this regard, a technique is hereby described in which three ports are directly inserted on the umbilical mound (without raising the umbilical-flap) through three small incisions to form an isosceles triangle. The respective fascial-entries are made farther away to achieve satisfactory inter trocar distance. This technique complies with the laparoscopic triangulation principles, likely to further reduce postoperative umbilical pain/morbidity, and achieve good umbilical aesthetics as the scars recede within the umbilicus. As only the routine laparoscopic instruments were utilized, it also has a potential to reduce the surgical cost. Therefore, the authors feel that this technique can be a valuable addition to the existing umbilical laparoscopic methods.

Roux-en-Y hepaticojejunostomy stricture is a substantial problem that develops in 10%-30% of patients and requires frequent intervention. Although endoscopic/percutaneous approaches are preferred, especially for refractory stricture, open surgical reconstruction remains the gold standard. However, such an operation may be highly challenging. The recently developed covered, self-expanding metallic stent is a useful option for such difficult cases. We present a case of recurrent Roux-en-Y hepaticojejunostomy stricture complicated by densely packed intrahepatic stones and suppurative cholangitis with failed percutaneous biliary draining. Enteroscopic manipulations were unfeasible, and the case was successfully managed by the laparoendoscopic approach. If treating surgeons have the necessary expertise, this technique may be considered in such difficult scenarios.

Secure closure of a laparotomy incision remains an important aspect of any abdominal operation with the aim to avoid the postoperative morbidity and hasten the patient's recovery. Depending on the operator's preference and experience, it may be done by the continuous or the interrupted methods either using a non-absorbable or delayed-absorbable suture. We describe a simple, secure and quick technique of abdominal wall closure which involves continuous suture inter-locked doubly after every third bite. This simple and easy to use mass closure technique can be easily mastered by any member of the surgical team and does not need any assistant. It amalgamates the advantages of both, the continuous and the interrupted methods of closures. To our knowledge, such a technique has not been reported in the literature.

Dear Sir, Lipoma is the commonest soft-tissue tumor occurring almost in any part of the body [1]. A special subtype—‘giant lipoma’ merits mention as it accentuates the presenting symptoms and offers diagnostic dilemma regarding its benign nature to the surgeon. In this paper we present a case of a giant hand lipoma. Sixty-one years old female presented with 4 × 4 cm swelling at her right thenar eminence since last 5 years (Fig. 1a). It was hindering her grasping activities so much so that she had to quit her job. Hand x-ray showed a diffuse soft-tissue shadow. Contrast-enhanced-magnetic-resonance-imaging showed 9.5 × 4.5 × 4cm homogeneous soft-tissue lump having superficial and deep components (Fig. 1b). It was masquerading further through 1st, 2nd till the 3rd web-spaces along the flexor digitorum tendons. Neuro-vascular structures were free. Hand-exploration through palmer-crease was performed to achieve its complete excision (Fig. 2a and b). She had a good postoperative recovery. Histopathology confirmed the benign nature of the lipoma. Fig. 1 a Thenar lipoma. Note its clinical extent. b MRI showing the complete extent of the giant lipoma. Note the coronal and the sagittal sections showing lipoma engulfing the tendons of flexor digitorum Fig. 2 Per-operative photograph showing initial part of lipoma projecting thru skin crease incision (a), followed by complete excision (b). c Completely resected specimen of giant lipoma. Note 9.5 × 4.5 × 4 cm ... It’s an interesting fact that hand lipomas are rare in spite of decent quantity of fat in palm region (1–3.8 %) [2]. Oster noted that the hand lipomas are peripherally positioned [2]. Their peripheral location may be due to thick mid-palmer fascia. They are unique in their presentation owing to limited palmer spaces (for their growth) surrounding important neuro-vascular structures. Mason further classified hand lipomas into superficial and deep palmar lipomas; the deeper ones are less common than the superficial ones and have complex variable morphology as noted in our patient [3]. Ones greater than 5 cm are designated as ‘giant’ lipomas and many of them have well-differentiated liposarcomatous components, which are difficult to differentiate from their benign counterparts [3, 4]. Patient usually approaches surgeon for compressive neurological symptoms, cosmesis, and fear of cancer (the 3 ‘C’s). Clinically small appearing hand lipomas may actually just be ‘a tip of ice-berg’ as found in our patient. Hence, they need a detailed imaging study by an MRI. Surgical excision remains the gold-standard for symptomatic and giant lipomas of the hand. Giant lipomas up to 8 cm have been reported in the literature [3, 4]. Our patient had 9.5 × 4.5 × 4 cm lipoma (Fig. 2c). Considering the ‘intricate anatomy’ of hand, a high quality imaging is necessary for their detailed study. A meticulous margin-free resection is the key for good results.

An enterolith is an infrequent clinical entity. It is generally diagnosed on imaging or at surgery. It is usually associated with underlying benign lesions like intestinal tuberculosis or Crohn's disease. Here, we report an unusual case of an elderly lady presenting with an acute small-bowel obstruction. On admission, her abdominal X-ray revealed a radio-opacity obstructing the jejunum. Her subsequent abdominal contrast-enhanced computed tomography revealed a big enterolith entrapped in a stricturous jejunal lesion. However, there was no pneumobilia. Consequently, she underwent an exploratory laparotomy followed by an "en-block" jejunal resection for suspiciously malignant impassable jejunal stricture. The cutopen specimen revealed 5 x 4 cm enterolith embedded in a tight ulcero-proliferative stricture. Histopathology confirmed jejunal adenocarcinoma. It is always prudent to suspect an underlying small-bowel malignancy while managing a seemingly straightforward case of small-bowel obstruction. The policy of prophylactic radical oncologic clearance may avoid inadvertent R1/R2 resections.

Liver retraction is an essential step during any laparoscopic upper gastrointestinal operation, especially during dissection at the oesophageal hiatus. However, the generally employed Nathanson retractor may cause significant postoperative liver dysfunction secondary to congestion of the liver.1,2 It may be technically cumbersome to systematize its frequent use intraoperatively and it may not be readily available at large. Furthermore, the unabated pressure it inflicts on the left lobe of the liver, especially during prolonged surgeries, may lead to hepatic ischaemic necrosis, gangrene, or even unexpected mortality.1 While few recently developed innovative liver retraction techniques seem useful in this context, 2-5 they tend to offer a “static” liver retraction. In this paper, we describe an easy-to-use method of laparoscopic liver retraction wherein any 5mm laparoscopic instrument can be used to manipulate the “heavy” liver so as to provide a “dynamic” counter-traction at will.

Up to six percent of patients develop trocar-related complications in laparoscopy. These problems are preventable if port sites are meticulously closed. By and large, there is a tendency to delegate this important step to the most junior member of the surgical team who needs an easy but secure method that does not demand expert assistance. Available literature documents over 15 different port closure methods. However, such methods are either technically difficult for a novice to reproduce or require special equipment that is rarely available, especially at a rural centre. In this context, we describe an extracorporeal technique for a fascial defect closure in which all day-to-day “open” surgery instruments are used. We performed over 6500 port closures by this method without any complications. Our junior surgical trainees quickly mastered the technique after a learning curve of just five cases. Moreover, it is likely to be a cheaper alternative since it does not require special instruments. Hence, it can be considered as a standard technique of port closure.