Essentials Of Laparoscopic Suturing Basics

Surgical knot tying is one of the first skills every medical student delights in mastering. One- and two-handed throws are next developed throughout the surgical residency for controlling hemorrhage or reapproximating tissues. Typically, surgical application of stapling devices follows mastery of basic suturing skills.

Laparoscopic urologic surgery is accomplishing the same fundamental operation as would an open incision, except with electronic imaging and small, fixed portals of access to the closed environment. The laparoscopic environment makes suturing and knotting a most difficult task (8,20).

It is for this reason that urologic reconstructive surgeries were, initially, only sporadically reported, and relied upon automated stapling technologies or short cuts with such instruments as the EndoStitchâ„¢a. Now large series typically utilize fully intracor-poreal suturing and knotting strategies.

It is doubtful that a urologist would perform any of the operations we do if told from the outset that suturing or knot tying could not be accomplished. It has been stated that laparoscopic urologic reconstruction can only be facilitated if there are developed stapling devices that can rapidly reapproximate tissue margins. These statements are made despite our continuing experience with metallic staples and the accompanying litany of complications when these are used within the genitourinary tract (21,22). Laparoscopic suturing is being performed throughout the world now for virtually every urologic reconstructive procedure. This review section will delve into the details of this most difficult of laparoscopic tasks. All aspects that have an impact upon suturing in this environment will be discussed. The focus will undoubtedly reflect the author's bias, centering on intracorporeal, two-handed, highly choreographed methods. In addition, detailed review of the literature of the most recent trends, especially in running suturing will be reviewed. Also the realm of robot-assisted reconstructions will also be considered.

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