Laparoscopic Surgical Techniques - Basic Skills and Suturing

Laparoscopic surgical techniques, basic skills, and suturing. Grasping the needle. First, the suture is grasped about 1 centimeter proximal to the needle at point C with the right-handed needle driver. Then the needle is grasped with the left-handed needle driver at point A between the distal and middle third of the needle. The needle is brought into position and grasped with the right-handed needle driver at point B between the middle and the proximal third of the needle. Further adjustments of the three-dimensional orientation of the needle can be made. Finally, the 3 dimensional orientation of the needle is controlled by pro and supination of the right-handed needle driver. Here an example is shown grasping the needle in a male newborn with a left-sided inguinal hernia. Even if the needle is oriented in the wrong direction, it can be brought into position using the same principles. If only one needle driver is available, the needle can be grasped and brought into position by slightly pressing the needle against the underlying tissue. Guiding the needle through the tissue. The needle is guided through the tissue by a supinating motion of the right-handed needle driver. The suture is held with the left-handed needle driver and the right-handed needle driver is used as a hypermoleon. Laparoscopic knot tying. The suture is oriented as a C and guided over the left-handed needle driver. The suture is then passed to the left-handed needle driver, orientated as an inverted C and guided over the right-handed needle driver. Laparoscopic sliding knot. After two inverted ties as shown before, the suture end with the needle and the suture coming out of the tissue are pulled apart 180 degrees in order to flip the knot. The knot is then slided towards the tissue and the tissue ends are pulled together. A sliding knot is used in a laparoscopic inguinal hernia repair. The suture end with the needle and the suture coming out of the tissue are pulled apart 180 degrees in order to flip the knot. Here another example. Two inverted ties are made in order to prepare the sliding knot. The suture end with the needle and the suture coming out of the tissue are pulled apart 180 degrees in order to flip the knot. Laparoscopic knot tying principles. The free suture end is grasped at its distal third if possible. The suture is handed over to the right-handed needle driver. Again, it should now be parallel to the left-handed needle driver. This is achieved by pro or supinating the right wrist. Here again, a laparoscopic inguinal hernia repair in a male newborn using the same principles. suture and needle driver should be parallel in order to be able to perform laparoscopic sutures with limited space. An example of a common mistake, the free suture end is grasped too proximally, resulting in a loop formation. Here, the left-handed needle driver should not be moved. The right-handed needle driver is brought into the loop, freeing up the free suture end. Laparoscopic suturing using a very short suture. The needle is grasped between distal and middle 3 and pulled apart from the suture in order to have the needle and the suture in one line in parallel to the free needle driver. Usually a laparoscopic suture should be about 10 centimeters in length. If the remaining suture is very short, one needle driver grasps the needle instead of the suture. This is associated with an increased risk of injuries to the surrounding tissues by the fixed needle. The needle is handed over to the left-handed needle driver between distal and middle third of the needle. Needle and suture are again pulled apart in order to have the suture and the free needle driver in parallel. Both needle drivers are moved synchronously, and the free suture end can be grasped. Cutting the suture. The suture end with the needle is brought in a position parallel to the free suture end. Both sutures can then be grasped by one needle driver, and the opposite hand can cut the suture.