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Art of Endosuturing
Parveen Bhatia, Suviraj J John, JP Singh Deed
CHAPTER 1:
Introduction
CHAPTER 2:
History
CHAPTER 3:
Basic Concepts
UTILITY OF LAPAROSCOPIC SUTURING
THE CHALLENGE
PREREQUISITE FOR LAPAROSCOPIC SUTURING
Perfect Health
Visual Perception Hand-eye Co-ordination
Motor Skill
Video Magnification and Camera Factors
Increasing Efficiency
Tissue Handling
TRAINING
CHAPTER 4:
Instrumentation
TROCARS
NEEDLE AND SUTURE
Needle Characteristics
Suture Characteristics
ENDOLOOPS
HAND INSTRUMENTS
Needle Holder
First Generation (Semm) Needle Holders—5 mm and 3 mm
Advantages
Disadvantages
Second Generation Needle Holders (Ethicon, Cook and Wolfe)
NEEDLE HOLDER/DRIVER
Throw Pushers
Grasping Forceps
Trainer
CHAPTER 5:
Basic Technique
SET UP
Laparoscope and Instrument Location
Principles of Port Placement
Principles of Instrumentation
NEEDLE CONTROL
Introduction of Needle Inside Abdomen
1. Using 5 mm Reducer
NEEDLE INTRODUCTION USING 5 mm REDUCER
NEEDLE INTRODUCTION USING 5 mm REDUCER (ALTERNATE TECHNIQUE)
2. Percutaneous
3. Using 5 mm Port (Reich method)
4. Using 10 mm Port
Loading the Needle
Adjusting the Needle
NEEDLE ADJUSTMENT BY TIP
NEEDLE ADJUSTMENT BY MANIPULATING SUTURE
NEEDLE ERECTION BY PRESSING OVER IT
Driving the Needle
ENTRANCE AND EXIT BITES
Selection of Entrance Point
Amount of Bite
Exit Bite
CHAPTER 6:
Intracorporeal Suturing Techniques
LINEAR INCISIONS AND LACERATIONS
Tissue Factors
Suture Factors
INTERRUPTED SUTURING
CONTINUOUS SUTURING
Suture Material
DUCTAL ANASTOMOSIS
End to End Anastomosis
End to Side Anastomosis
Side to Side Anastomosis
TIPS
CHAPTER 7:
Intracorporeal Knot Tying
TYPES OF INTRACORPOREAL SURGICAL KNOTS
Square Knot (Fig. 7.1)
Square Slip Knot (Fig. 7.2)
Advantages
Ligature Slip Knot (Fig. 7.3)
Surgeon's Knot (Fig. 7.4)
Jamming Slip Knot (Starter Knot)
Aberdeen Knot (Terminal Knot)
TECHNIQUE OF INTRACORPOREAL KNOTTING
The Suture
Selection of Suture Material
The Instruments
Creation of ‘C’ Loop (Figs 7.9 to 7.11)
Wrapping (Figs 7.12 to 7.17)
Tail Pick Up and Configuration of the Knot
Tightening and Completion of First Half Knot
Configuration of Subsequent Knots
TECHNIQUE OF INTRACORPOREAL KNOTTING: CREATION OF C LOOP
TECHNIQUE OF INTRACORPOREAL KNOTTING: WRAPPING
TECHNIQUE OF INTRACORPOREAL KNOTTING: WRAPPING
TECHNIQUE OF INTRACORPOREAL KNOTTING: TAIL PICK UP
TECHNIQUE OF INTRACORPOREAL KNOTTING: TIGHTENING
TECHNIQUE OF INTRACORPOREAL KNOTTING CREATION OF ‘C’ LOOP ON CONTRALATERAL SIDE
TECHNIQUE OF INTRACORPOREAL KNOTTING: WRAPPING
TECHNIQUE OF INTRACORPOREAL KNOTTING TAIL PICK UP AND TIGHTENING
Completion of Knot
INTRACORPOREAL TWIST TECHNIQUE
SQUARE SLIP KNOT
SQUARE SLIP KNOT: STEPS
KNOT SUBSTITUTES
ERGONOMICS IN INTRACORPOREAL SUTURING
CHAPTER 8:
Extracorporeal Knot Tying
TECHNIQUE OF SUTURING USING EXTRACORPOREAL KNOTS
TYPES OF EXTRACORPOREAL KNOTS
Roeder Knot (Figs 8.3 to 8.23) (Aide memoire 1-3-1)
ROEDER KNOT: STEPS
ROEDER KNOT: STEPS
ROEDER KNOT: STEPS
ROEDER KNOT: STEPS
ROEDER KNOT: STEPS
ROEDER KNOT: STEPS
Melzer Knot (Figs 8.25–8.53) (Aide memoire 2-3-2)
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
MELZER KNOT: STEPS
Texas Endosurgery Institute Knot (TEI knot)
Duncan Slip Knot
Tayside Knot
The Indian Rope Trick
DRAWBACKS OF EXTRACORPOREAL KNOTTING
CHAPTER 9:
Common Errors and Remedies
LOOSENING OF KNOT
Remedy
CORRECTION OF LOOSENING OF FIRST HALF KNOT
UNRAVELING OF KNOT
Remedy
SHORT SUTURE LENGTH
Remedy
Half moon effect
HALF MOON EFFECT: MANAGEMENT OF SHORT SUTURE LENGTH
INCORRECT LOOP FORMATION
‘S’ Loop Formation
Reversed ‘S’ Loop
‘O’ Loop
CROSSING INSTRUMENTS
NEEDLE DEFLECTION AND REMEDY
Cause
Solution
COMPLICATIONS OF SUTURING
Remedy
Remedy
CHAPTER 10:
Useful Accessories
CLIPS AND CLIP APPLIERS
SEWING DEVICES
LIGATING INSTRUMENTS
ENDOSURGICAL STAPLING
FIBRIN GLUE
BIOFRAGMENTABLE ANASTOMOSIS RING (BAR)
CHAPTER 11:
The Future… is Here!
INDEX
TOC
Index
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