The art of suturing
Wound closure is a necessary, but meticulous part of surgery, especially during minimally invasive surgery. Suturing with needle and thread takes a long time to master and can be especially time-consuming for inexperienced surgeons. The required precision makes it one of the most difficult actions within laparoscopic surgery [1, 2].
An example of challenging laparoscopic suturing is vaginal cuff closure after hysterectomy, which requires precisely placed sutures, deep in the pelvic area. Figure 1 illustrates this in a phantom model of the vaginal cuff.
The process is so difficult, because a small needle needs to be handled by the grasper located at the end of a long instrument. There is roughly only one correct approach and the placement of the stiches is very specific. The perfect placement is obtained by many different instrument actions.
Wietske Beers, graduation intern:
“Working on the Hornet has been an exciting and educational experience. The project combines the best parts of R&D: innovation, (mechanical) design, and working with medical professionals. During my time on the project, we made significant design changes and built 2 different working prototypes.”
An innovative solution behind the intuitive system
In line with DEAM’s vision of making the surgeon’s work easier, the goal of this project is to develop a new, innovative way to suture faster, in a precise manner, needing less instrument actions. This is established by making a system that secures the needle in an intuitive way, taking away problems with positioning the needle in a grasper. A sneak peek of the new way of suturing with this device is shown in Figure 2.
In the Hornet, the needle is secured to the end of the long instrument, and thus always optimally positioned. Figure 3 shows the narrow shaft of the hornet, with the needle currently threading the suture through the tissue. Vaginal cuff closure after hysterectomy was selected as the initial procedure for which the Hornet is designed and optimised.
Smoother suturing for all?
A functional prototype has been made and will be tested soon. Time saving, usability and precision as opposed to the current systems will be assessed for vaginal cuff closure.
The Hornet aims to be a truly innovative way of suturing, applicable to many minimally invasive procedures.
References:
[1] N. T. Nguyen, K. L. Mayer, R. J. Bold, M. Larson, S. Foster, H. S. Ho, and B. M. Wolfe, “Laparoscopic suturing evaluation among surgical residents.”, The Journal of surgical research, vol. 93, pp. 133-136, 2000.
[2] J. G. Pattaras, G. S. Smith, J. Landman, and R. G. Moore, “Comparison and analysis of laparoscopic intracorporeal suturing devices: preliminary results.”, Journal of endourology / Endourological Society, vol. 15, no. 2, pp. 187-192, 2001.
November 18, 2020
