Intracorporeal suturing in minimally invasive surgery

A tested suturing device makes it easier and less expensive for veterinary surgeons to perform this technique.
Nov 01, 2004

John C. Huhn, DVM, MS
Minimally invasive surgery is a rapidly developing discipline in veterinary medicine, thanks to its widespread use in human medicine. During the past 20 years, veterinarians have watched a temporally similar development with arthroscopic surgery. While minimally invasive surgery has many advantages over traditional open surgery—including reduced postoperative pain, reduced recovery times, and improved operative results—there is a caveat: It requires specialized training and considerable experience. In this article, I'll focus on one particular minimally invasive technique—intracorporeal suturing.

Figure 1: Endo Stitch device (Tyco Healthcare/Kendall Animal Health). Figure 2: At the Endo Stitch training station, two 5-mm-to-12-mm laparoscopic ports are used to insert the Endo Stitch device, and laparoscopic grasping forceps are used to suture simulated wounds in the central foam block. An angled plexiglass sheet is affixed to the rear of the training station to support the Endo Stitch knot-tying manual.
The power of ports Intracorporeal suturing involves suturing within a body cavity (abdomen or thorax) through one or more operative ports. Laparoscopic ports generally accept surgical instruments with diameters ranging from 5 to 12 mm. Furthermore, these ports incorporate a one-way seal that prevents insufflating gas (generally CO2) from escaping during operative manipulations. Thoracoscopic ports accept instruments with the same diameters, but they generally don't include seals that prevent gas from escaping because the lung is allowed to collapse during surgery.

Figure 3: Knot-tying Techniques—Square Knot
One of the most important goals of minimally invasive surgery is to perform it in a hemostatic and atraumatic closed environment. New laparoscopists frequently begin a given procedure as a minimally invasive one, only to convert to an open procedure when technical problems arise. With patience, time, and experience, laparoscopists can perform minimally invasive surgical techniques from start to finish. In the interim, many choose to use a laparoscopic-assisted technique until their proficiency improves. One such technique is intracorporeal suturing, which allows veterinarians to place hemostatic or appositional ligatures through conventional laparoscopic or thoracoscopic ports.

Variation on a conventional method Veterinarians can perform intracorporeal suturing by using specialized needle graspers and conventional suture material or a specialized suturing device, such as Endo Stitch (Figure 1). The first method is difficult to master and requires expensive instrumentation. The latter method is considerably easier, and the required equipment is much more affordable. Furthermore, the Endo Stitch device comes with a training station (Figure 2), which allows laparoscopic surgeons to practice knot-tying before intraoperative use (Figure 3).