Suturing Aids in Endoscopic Surgery
Suturing and knot tying in endoscopic surgery requires the correct technique and hours of practice to effortlessly tie knots. However, aids have been developed for assisting the surgeon to tie knots. A list of devices and instruments that assist in the su
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70 Suturing Aids in Endoscopic Surgery Amulya K. Saxena
70.1
Self-Righting Needle Holders
Smart needle holders are designed to automatically self-right the needle to the correct position in the holder when the jaws of the needle holder are closed (Sarbu™; Richard Wolf, Knittlingen, Germany). Furthermore, they have a built-in suture cutter to avoid instrument changes once the suture has been tied. (Courtesy of Richard Wolf, Knittlingen, Germany)
70.2
Sew-Right Sewing Device
The Sew-Right® SR•5 (LSI Solutions, Victor, NY, USA) is a reloadable 5-mm sewing device. To sew: (1) the needle is passed through tissue, (2) after which it automatically captures the suture, (3) and pulls it back through the tissue; (4) The second needle can be selected to take the second bite; after which the two ends are tied.
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Chapter 70 Suturing Aids in Endoscopic Surgery
70.3
Quik-Stitch® Suturing System
The Quik-Stitch® endoscopic suturing system (Pare Surgical, Englewood, CO, USA) is a 5-mm delivery system with a pretied Roeder knot. It consists of a 5mm reusable, stainless-steel handle, 2.1-mm reusable needle driver, and a patented suture spool with a straight taper point or blunt-tip needle. (Courtesy of Pare Surgical, Englewood, CO, USA)
70.4
Clip Knots for Continuous Sutures
Lapra-Ty-II™ (Ethicon, Somerville, NJ, USA) are absorbable suture clips made of polydiaxanone polymer to secure the ends of suture. A special clip applicator is necessary to secure the clip on the suture ends. (Courtesy of Johnson & Johnson Medical Products, Ethicon, Vienna, Austria)
Amulya K. Saxena
70.5
Busche Port-Site Closure Device
Port sites > 5 mm have to be closed to prevent portsite hernias, especially in adolescent bariatric surgery. The Busche port-site closure device (Richard Wolf, Knittlingen, Germany) comprising of a guide (top) and a grasping forceps (bottom) with a sharp tip (inset) is a useful tool for port-site closure. (Courtesy of Richard Wolf, Knittlingen, Germany)
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70.5.1
Technique of Port-Site Closure with the Busche Device
Step 1: The guide is first introduced into the port site, after which the grasping forceps with suture is inserted through it. (Courtesy of Richard Wolf, Knittlingen, Germany)
Step 2: The Forceps exit point must not be close to the defect edge to ensure full-thickness closure. The suture is released with ~4 cm length in the abdomen. (Courtesy of Richard Wolf, Knittlingen, Germany)
Amulya K. Saxena
Step 3: The forceps is partially retracted into the guide. With the retracted forceps, the guide is rotated 180° and the forceps reintroduced in the abdomen. (Courtesy of Richard Wolf, Knittlingen, Germany)
Step 4: The forceps grasps the suture and then is then partially retracted into the guide. The guide and the forceps are removed and the knot tied extracorporeally. (Courtesy of Richard Wolf, Knittlingen, Germany)
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Chapter 70 Suturing Aids in Endoscopic Surgery
70.6
EndoStitch Suturing Device
The Autosuture™ EndoStit
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