Surgery has evolved such that the current era has embraced the adoption of minimally invasive surgery (MIS) where feasible [1]. MIS confers several advantages including the use of smaller incision sites which infer reduced postoperative pain, less intraoperative blood loss, enhanced recovery times, reduced post-operative complications and improved cosmesis [2]. Moreover, some advantages of MIS, namely cosmesis and certain post-op complications, such as wound infection and dehiscence rates, are directly confounded by the closure methodology deployed in closing port site skin wounds.

Multiple wound closure techniques are now utilised for closing laparoscopic post sites, with sutures (SU), stapled (ST) and tissue glue (TG) closures among the most common conventional strategies employed by surgeons [3]. Subcuticular technique using absorbable sutures have become common practice due to the perceived augmentation of the aesthetic outcomes relative to the other methods [4]. ST are advantageous due to the speed and cost-effectiveness of this closure method, with minimal training required for a competent closure [3]. Moreover, previous data illustrate similar healing times and infection rates relative to sutured closures [5]. Adhesives, such as TG, are becoming increasingly popular as an alternative to sutured closures, due to their reported speed, cost-effectiveness, and improved cosmetic outcomes, as well as mooted reduced infection rates [6].

At present, much debate surrounding the optimal method of skin closure following MIS remains, with no ‘gold standard’ closure methods recommended in expert consensus statements and guidelines. Instead, port site closure methods are typically surgeon and/or institution dependent in contemporary surgical practice. On extensive review of the surgical literature, there are no previous prospective randomised clinical trials (RCTs) performed which directly compare the SU, ST and TG for closing port site wounds. Accordingly, the aim of this study was to perform a prospective multicentre RCT which directly compared SU, ST and TG for closing port site wounds to primarily assess wound cosmesis, with secondary aims of evaluating the rate of wound complications, speed of wound closure, cost-effectiveness and surgical sustainability in order to fully establish the optimal wound closure method.