Troubleshooting |
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Fig. 16.8 Roeder’s knot for extracorporeal knot-tying, using a 35-in. (90 cm) thread
Endoloop
It is also possible to use preformed knots such as Endoloops. The way to secure an Endoloop is to make sure that the organ to be knotted in the endoloop is free at one end, and then to pull it inside the loop with a grasper (Fig. 16.9).
One trick to avoid tearing the tissue is to place the grasper within the abdominal cavity to create a pulley effect, placing tension on the suture and not on the tissue. Next, bring the needle out, tie a knot and use the knot pusher to push the knot into the abdomen.
Lost Needle
If the needle is lost, do not move or insert any instruments. First, one should look inside the trocar as the needle may be caught within the shaft of the trocar. Then the scope is moved from the main trocar and placed into the working trocar to look for the needle. Next, one should examine the abdominal cavity without manipulating any tissue. The needle may be floating on the fat (Fig. 16.10 1, 2, 3). Once the tissue has been moved, the needle can slide into the tissue and sometimes may even be impossible to find, even requiring conversion to an open operation.
Short Suture
If the thread is very short and a critical suture has been placed and cannot be redone, the needle can be used to increase the length of the thread.Again, the needle should be in the smiling position, keeping the loose end on the side of the needle (STLE: The tip of the needle has to be on the side of the loose end), and otherwise using the same movements as in intracorporeal knot-tying to complete the knot.
Trouble shooting
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Chapter 16 Advanced Laparoscopic Suturing Techniques |
Fig. 16.9 Knot-tying using an Endoloop suture
1
2 
3
Fig. 16.10 Different usual location of lost needles: 1 needle located in the base of the trocar; 2 needle in trocar sleeve; 3 needle just located “floating” on fat, near the intra-abdominal tip of the trocar
Selected Further Reading |
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Ahmed S, Hanna GB, Cuschieri A (2004) Optimal angle between instrument shaft and handle for laparoscopic bowel suturing. Arch Surg 139(1):89–92
Facchin M, Bessell JR, Maddern GJ (1994) A simplified technique for laparoscopic instrument ties. Aust NZ J Surg 64(8):569–71
Fried GM, Feldman LS,Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 240(3): 518–25
Garcia-Ruiz A, Gagner M, Miller JH, Steiner CP, Hahn JF (1998) Manual vs robotically assisted laparoscopic surgery in the performance of basic manipulation and suturing tasks. Arch Surg 133(9):957–61
Jamshidi R, LaMasters T, Eisenberg D, Duh QY, Curet M (2009) Video self-assessment augments development of videoscopic suturing skill. J Am Coll Surg 209(5):622–5 Mackay S, Datta V, Chang A, Shah J, Kneebone R, Darzi A (2003) Multiple Objective
Measures of Skill (MOMS): a new approach to the assessment of technical ability in surgical trainees. Ann Surg 238(2):291–300
Madan AK, Harper JL, Taddeucci RJ, Tichansky DS (2008) Goal-directed laparoscopic training leads to better laparoscopic skill acquisition. Surgery 144(2):345–50
McDougall EM, Kolla SB, Santos RT, Gan JM, Box GN, Louie MK, Gamboa AJ, Kaplan AG, Moskowitz RM,Andrade LA,Skarecky DW,Osann KE,Clayman RV (2009) Preliminary study of virtual reality and model simulation for learning laparoscopic suturing skills. J Urol 182(3):1018–25
Rosser JC, Rosser LE, Savalgi RS (1997) Skill acquisition and assessment for laparoscopic surgery. Arch Surg 132(2):200–4
Rosser JC Jr, Rosser LE, Savalgi RS (1998) Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons. Arch Surg 133(6):657–61
Ruiz de Adana JC, Hernández Matías A, Hernández Bartolomé M, Manzanedo Romero I, Leon Ledesma R, Valle Rubio A, López Herrero J, Limones Esteban M (2009) Risk of gastrojejunal anastomotic stricture with multifilament and monofilament sutures after hand-sewn laparoscopic gastric bypass: a prospective cohort study. Obes Surg 19(9):1274–1277
Schwarz RE, Julian TB (1995) A simple way to finish a continuous laparoscopic suture. Surg Endosc 9(5):547–548
Shatz DV, Block EJ, Kligman M (1994) Laparoscopic suturing technique for enteral access procedures. Surg Endosc 8(6):717–718
Wattanasirichaigoon S (1997) Triple-loop knot for securing a running suture in laparoscopic surgery. Br J Surg 84(3):422
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Further
Reading