Comparison and analysis of laparoscopic intracorporeal suturing devices: Preliminary results

Background and Purpose: One of the most challenging aspects of laparoscopic surgery is intracorporeal suturing and knot tying. A loss of depth percept ion and tactile sense and visual obstruction make placing accurate and well -tied knots a difficult and time-consuming task. Two devices conceived to e ase the task of suturing and knotting while presumably speeding performance are the Suture Assist (SA; Ethicon Endo-Surgery) and EndoStitch (ES; US Su rgical/Tyco). We set out to objectively assess suture placement accuracy an d knot speed and strength of these two suturing devices and conventional la paroscopic suturing (CS). Materials and Methods: To date, six surgeons with laparoscopic experience w ere trained on the three suturing techniques. A pelvic trainer was set up w ith a freshly marked and incised swine renal pelvis and ureter. Each surgeo n placed four sutures of 2-0 polyester suture with each technique (repeated on three separate occasions) with five half-hitches for a total of 216 kno ts. Time, strength, and accuracy were measured for each suture/knot placeme nt. The knot distance was then measured from the marked target using calipe rs and carefully dissected from the tissue. Each knot was individually test ed on a Monsanto Model 10 tensiometer, whereby slippage, strength, and brea kage points were determined. Results: The mean times (min:sec) and accuracy (millimeters) were as follow ing: CS 5:08 and 0.457, ES 2:45 and 0.660, and SA 2:40 and 0.508. The diffe rence in time was found to be statistically significant (P < 0.001), while the difference in accuracy was not. Only 182 of 216 knots were able to be i ncluded for analysis because of either a small knot lumen or device failure . Device failures necessitating intervention were encountered only with the SA, which had a misfire rate of 9.7% (7 of 72). The mean knot strength was measured at 41.1 N for CS, 57.3 N for SA, and 28.0 for ES, Knot break perc entage (breakage) was calculated as 50.8% for CS, 20.7% for ES, and 95% for SA. Conclusion: Preliminary results show that each of the laparoscopic suturing devices has distinct advantages over conventional intracorporeal suturing and tying. Decreased times and comparable, if not greater, knot strengths m ay translate into improved laparoscopic suturing/tying performance for lapa roscopic intracorporeal suturing devices.