A laparoscopic knot-tying device for minimally invasive cardiac surgery☆

Abstract

Objectives Intracorporeal suturing and knot tying can complicate, prolong or preclude minimally invasive surgical procedures, reducing their advantages over conventional approaches. An automated knot-tying device has been developed to speed suture fixation during minimally invasive cardiac surgery while retaining the desirable characteristics of conventional hand-tied surgeon's knots: holding strength and visual and haptic feedback. A rotating slotted disk (at the instrument's distal end) automates overhand throws, thereby eliminating the need to manually pass one suture end through a loop in the opposing end. Electronic actuation of this disk produces left or right overhand knots as desired by the operator. Methods To evaluate the effectiveness of this technology, 7 surgeons with varying laparoscopic experience tied knots within a simulated minimally invasive setting, using both the automated knot-tying tool and conventional laparoscopic tools. Suture types were 2-0 braided and 4-0 monofilament. Results Mean knot-tying times were 246 ±116 seconds and 102 ±46 seconds for conventional and automated methods, respectively, showing an average 56% reduction in time per surgeon (p=0.003, paired t-test). The peak holding strength of each knot (the force required to break the suture or loosen the knot) was measured using tensile testing equipment. These peak holding strengths were normalized by the ultimate tensile strength of each suture type (57.5 N and 22.1 N for 2-0 braided and 4-0 monofilament, respectively). Mean normalized holding strengths for all knots were 68.2% and 71.8% of ultimate tensile strength for conventional and automated methods, respectively (p= 0.914, paired t-test). Conclusions Experimental data reveal that the automated suturing device has great potential for advancing minimally invasive surgery: it significantly reduced knot-tying times while providing equivalent or greater holding strength than conventionally tied knots.

Automation of a suturing device for minimally invasive surgery

“…Similar to this work, the efficacy of automated anastomotic devices has been assessed in heart surgery [15][16][17][18] and endourology [19]. Although based on different technical principles, shortening the duration of anastomosis is the main advantage.…”

Shalaby technique for efficient single incision laparoscopic pediatric inguinal hernia repair

“…However, because this is a technique of percutaneous closure of inguinal hernias, the inclusion of tissues between the skin and hernia sac, including nerves and muscles, may cause injury and increase the postoperative morbidity in the long[6][7][8][9][10][11][12][13]. In addition to the suture may cut through the muscles with subsequent loosening of the suture around IIR causing recurrence of the hernia.…”

“…In addition, entangling of muscular tissues with the suture may result in increased rate of recurrence due to loosening of the suture and cut through the muscular tissues. [6,7] In laparoscopic surgery, intracorporeal knot tying involves the use of two instruments with comfortable angels while in SIPES it is not usually possible to utilize two instruments for knot tying as they lie almost parallel without triangulation making the suturing and knot tying very challenging tasks [1,8]. That has stimulated us to introduce a hybrid of techniques and innovated others to develop a simple easy and secure way for single incision laparoscopic hernia repair Ninety-five percent of patients were available for follow-up at a mean of 2.±24.2 years (range=10 month -3 years) and all showed an excellent cosmetic result with nearly invisible scar.…”

Laparoscopic intracorporeal knot tying using a novel device

“…To address these inherent problems of laparoscopic knot tying, various devices, suture-free alternatives, and even a robotic system have been designed and developed with the hope of making knot tying quicker and easier [1][2][3][4][5][6][7][8][9]. Each of the laparoscopic knot-tying devices has distinct advantages [2].…”

“…However, the experimental group had a lower knot failure rate (5 vs. 40%, P = 0.02) and shorter knotting time (37.0 ± 9.2 vs. 107.0 ± 47.7 s, P \ 0.001) compared with the control group. Conclusions This novel device significantly shortened the knotting time of laparoscopic intracorporeal knot tying, and did not compromise the success rate or strength of the knot.Keywords Laparoscopic intracorporeal knot tying Á Device-assisted knot tying Á Double sheet bend Á Two-turn flat square knot Laparoscopic intracorporeal knot tying is traditionally considered as a difficult skill in laparoscopic surgery, and learning to tie knots intracorporeally in a two-dimensional environment, especially with limited visibility and depth perception and awkward angles, is a challenging and frustrating experience for most inexperienced surgeons [1][2][3][4]. To address these inherent problems of laparoscopic knot tying, various devices, suture-free alternatives, and even a robotic system have been designed and developed with the hope of making knot tying quicker and easier [1][2][3][4][5][6][7][8][9].…”