Running suturing: The ideal length facilitates this task

Background and Purpose: Laparoscopic intracorporeal suturing is difficult, a complex task involving several integrated skills such as needle handling, suturing, and knotting. Running suturing is even more complex in the close d environment secondary to the angles of the suture lines, the tension main tained on the suture line, and the need to secure the ends, including tying a knot from the tail of the suture to the loop of the preceding stitch. We have hypothesized that the ideal suture length facilitates this process, a nd this study was specifically designed to determine the ideal suture lengt h for an intracorporeal running suture. Materials and Methods: Latex phantoms were incised for 1 or 2 cm, and each was marked with black points to indicate suture entrance and exit sites. Th ese marks were placed 2 mm from the incision, starting 2 mm proximally and ending 2 mm distally. Suture lengths could then be varied in direct proport ion to the length of the incision, keeping all of these points as constants . The ratios of suture length:incision length were 9:1, 10:1, and 11:1. One surgeon performed all of the running suturing utilizing dry 3-0 coated pol yglactin with a tapered SH needle. The times needed to create running sutur e lines were recorded (seconds), the number of ideal entrance and exit poin ts tabulated, and the number of technical errors (missed movements resultin g in-prolonged suturing) recorded. Results: The lengths of both the incision and the suture affect the ability to perform laparoscopic intracorporeal running suturing. As the incision i ncreased, the suture:incision ratio of 9:1 resulted in the most efficient r esults (quickest suturing and fewest errors). In smaller suture lines (1 cm ), the ratios 10:1 and 11:1 appeared better. Conclusions. A suture:incision ratio of 9:1 is best for longer suture lines and 10:1 is better for short suture lines.