Endosuturing and Tissue approximation in Laparoscopic Surgery

Laparoscopic suturing is used for approximation of tissues and it is also an effective way of providing haemostasis. Suturing for haemostasis and reformation of anatomic structures has long been considered one of the most demanding endoscopic technical skills.

Endoscopic procedures are performed by looking at a two dimensional monitor with up to 6 times magnification, eliminating depth perception and direct tactile feedback; this requires significant hand – eye co-ordination and training. The more advanced endoscopic procedures require the laparoscopic surgeon to master suturing. For this reason, you find that most junior doctors have not mastered this skill and often registrars will struggle with this.

In the context of laparoscopic suturing, knots can be categorised as either intracorporeal or extracorporeal. Intracorporeal knots are tied within the body cavity utilising needle holders and extracorporeal knots are tied outside the body cavity.

Our Intracorporeal suturing course utilises short segments of string to first help participants understand the mechanics of laparoscopic knot tying (as pictured above). We then move on to using sutures and guide participants through a range of suturing techniques of increasing difficulty.

One of the tasks that we use for the purpose of training involves using laparoscopic instruments to open sutures from their original packaging without damaging the cardboard insert, the participant must then load the needle before commencing the suturing task at hand. It is a true test of dexterity and hand eye co-ordination. This challenge ties in a range of skills that are taught on the day and a special prize is given for the best execution.