Braided vs. Monofilament
braided sutures easier to handle, no elastic memory, less tendency to fray, less throws per knot
What’s safer: taper vs. cutting suture?
taper
What size needle can pass through a trocar?
10mm
- can also remove ports backload, and place suture directly through skin if 3-5mm port
Grasp suture 5-10 mm from junction, not needle, when bringing through port in and out of abdomen
Pro vs. Cons of
1. Interrupted sutures
2. Running sutures
- a. less cumbersome, less suture intra-abdominally
b. requires extra knots - a. Less knots
b. longer suture, need tension
How long should suture be for intracorpooreal knot suturing?
15cm (6in)
Optimal port position for knot tying means ports are far enough so elbows are flexed at 90 degrees and adjacent to surgeons body, ports should be at least 10 cm apart
Ideal orientation for suturing is from 3 to 9 o’clock
How long should suture be for extracorporeal suturing?
- 30 inches (76cm),
pull suture through same port, use assisting instrument as fulcrum
May loose pneumoperitoneum if suture holds valve of port open
Open: thrown knot, then knot pusher
Closed: put on knot pusher first, then tie in front of pusher
Cut with scissors in same port
- Can also use Roeder’s knot: tie knot extracorporeally, then slide down with knot pusher
- Flat square knot
- Wrap strand around both strands 3x
- Free end between two strands and last 2 wraps and cinched down
- **This is an ENDOLOOP
Uses: cut end of vessel, appendix, fallopian tube, cut end of cystic duct
What are the options for mechanical tissue approximation?
Suture vs. Clips vs. Linear staplers
sizes of clips
small 5mm, large 10mm
simple but expensive
what size port is used for linear staplers?
12mm port
- Relatively expensive
- Cartridges can ben 30-60mm
- Staple size is 2-4.5mm
- Articulating shaft
- Staple height
Smallest (2-2.5mm)= vascular application (WHITE)
Medium (3-3.5mm)=GI tract (BLUE)
Large (4-4.5mm)= dist stomach, thickened GI tract (GREEN)
