Laparoscopic Suturing And Knotting

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  • 1. Laparoscopic Suturing And Knotting Dr. Pradeep Kumar Garg Assistant Professor Department of Obstetrics & Gynaecology AIIMS, New Delhi Email:pkgarg_in2004@yahoo.com

2.

  • To see videos on laparoscopic gynae surgeriesplease logon towww .youtube.com
  • and type Pradeep aiims

3. Port Placement 4. Ipsilateral Suturing

  • Advantages of Ipsilaeral
  • Less fatigue
  • More useful for surgeries like myomectomy where more numbers of sutures are usually taken

5. Ipsilateral Suturing 6. Contralateral Suturing

  • More fatigue
  • Obstructs the assistant and camera movements
  • Waste of one port and assistants hand

7. Contralateral Suturing 8. Our preference in Suturing

  • Ipsilateral intracorporeal suturing for ligating uterine arteries and vault closure in cases of TLH, myomectomy, tunboplasty mesh fixation in cases of vault prolapse, repair of bladder, bowel.

9. Needle holders

  • Light weight
  • Sand blasted i.e. nonreflecting surface
  • Optimum width/breadth of the jaw is neither too wide nor too pointed
  • Deep cirsscross serrations on the grasping surface of the jaws
  • The jaws that is grasping portion of the needle holder should be in line with the long axis of the barrel of the instrument.
  • Handle should have less ratchets / catch.

10. Suture Material

  • Suture length ?
  • Vicryl is preferred over the monofilament suture material
  • Memory?
  • Excellent knotting property
  • Gortex Monofilament, good sliding, less memory
  • Monofilament Ethibond, PDS, Monocryl

11. Use of pelvic trainers and simulators to teach endoscopic suturing

  • Type :1. Box trainers, 2. VR trainers
  • Box trainers:
  • Significantly cheaper
  • Authentic instrument to which he she is accustomed,same feel and shape
  • True force feedback as they are physical objects
  • Allows for leaning the characteristics of various type of knots as well as suture material
  • DisadvantageActual needle and suture material is required.

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