Retroperitoneoscopic and laparoscopic suturing: Tips and strategies for improving efficiency

Background: The difficulties of minimally invasive reconstructive surgery, laparoscopically or retroperitoneoscopically, are caused by spatial limitat ion and fixed trocar positions and, therefore, restricted movement and hand ling of the instruments. In addition to a standardization of the technique, continual training, and improved instrument technologies, optimization of the geometry of reconstructive surgery, such as angles and distances betwee n the working ports or the camera and needle position, are imperative to pr oviding an optimal clinical performance. Materials and Methods: After designing a standardized suturing technique an d conducting an experimental analysis of the geometric factors important in reconstructive surgery, we transferred these results to our clinical setti ng. A series of 116 reconstructive laparoscopic and retroperitoneoscopic pr ocedures (nephropexy, pyeloplasty, bladder neck suspension, and radical pro statectomy) were analyzed according to the technical realization and qualit y of reconstruction. Trocar and table positions were adjusted according to our preliminary results, as were the position of the instruments and camera . Results: The trocar and instrument positions are critical for the clinical outcome of reconstructive surgery. Continual training in a standardized sut uring technique, together with the clinical application of the important ge ometric rules, can reduce surgery time by 50%, The time required for suturi ng single knots could be decreased even more: as much as 75%, thus ensuring efficient and safe reconstructive surgery. Conclusion: Reconstructive procedures such as pyeloplasty or radical prosta tectomy can be standardized and performed in an acceptable amount of time w ith adequate quality when adhering to a standardized technique and the impo rtant geometric rules. Improved performance in terms of time and quality wi ll increase the acceptance of these procedures, which can help to solve the problem associated with a low total number of indications for laparoscopy and retroperitoneoscopy.