Laparoscopic Suturing And Knotting

Dr. Pradeep Kumar GargAssistant Professor

Department of Obstetrics & Gynaecology

AIIMS, New DelhiEmail:pkgarg_in2004@yahoo.com

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Port Placement

Ipsilateral Suturing

Advantages of Ipsilaeral

• Less fatigue

• More useful for surgeries like myomectomy where more numbers of sutures are usually taken

Ipsilateral Suturing

Contralateral Suturing

• More fatigue

• Obstructs the assistant and camera movements

• Waste of one port and assistants hand

Contralateral Suturing

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.

Needle holders1. Light weight2. Sand blasted i.e. nonreflecting surface3. Optimum width/breadth of the jaw is

neither too wide nor too pointed4. Deep cirsscross serrations on the

grasping surface of the jaws5. The jaws that is grasping portion of the

needle holder should be in line with the long axis of the barrel of the instrument.

6. Handle should have less ratchets / catch.

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

Use of pelvic trainers and simulators to teach

endoscopic suturing Type : 1. Box trainers, 2. VR trainers Box trainers : 1. Significantly cheaper 2. Authentic instrument to which he she is accustomed, same

feel and shape 3. True force feedback as they are physical objects4. Allows for leaning the characteristics of various type of

knots as well as suture material

Disadvantage Actual needle and suture material is required.

For queries mail me at

pkgarg_in2004@yahoo.com