Geometry of laparoscopic suturing and knotting techniques

被引:51
作者
Frede, T [1 ]
Stock, C [1 ]
Renner, C [1 ]
Budair, Z [1 ]
Abdel-Salam, Y [1 ]
Rassweiler, J [1 ]
机构
[1] Klinikum Heilbronn, Dept Urol, D-74078 Heilbronn, Germany
关键词
D O I
10.1089/end.1999.13.191
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Spatial limitation, together with a fixed trocar position, restricted handling, and movement of the instruments, is inevitably associated with reconstructive laparoscopy and retroperitoneoscopy. This problem includes not only suturing technique and instruments but also geometric factors of endoscopic reconstruction, such as optimal distances between the working trocars, length of instruments, and angles between the instruments and the object. We present an experimental access to determine the specific impact of these factors on reconstructive laparoscopy. Materials and Methods: In an in vitro model, end-to-end anastomoses of porcine intestine were performed using a standardized intracorporeal suturing technique. Suturing was performed without and after training in reconstructive surgery with variation of the following geometric factors: (1) the distance between the working trocars (between 6 and 12 cm); (2) the position of the object (lateral right, medially, lateral left); (3) the camera position (medially, lateral right, lateral left); (4) the angle between the instruments and a horizontal line (15 degrees, 55 degrees, 90 degrees); (5) the intracorporeal length of instruments (between 10 and 25 cm); and (6) narrowed space available for the instruments (between 4 and 25 cm). Results: Continual training decreased the time required for suturing between 30% to 50%. Training decreased the time required for nonsuturing activities between 50% and 70% but the time required for suturing activities only between 20% and 45%. If the space between instruments and camera was limited, shifting the camera into a lateral position simplified the procedure of intracorporeal suturing. Angles of <55 degrees between instruments and the horizontal line simplified laparoscopic suturing, as did angles of <45 degrees between the instruments. In cases of maximally narrowed space (diameter of 4 cm), a suture filament length of <10 cm decreased the time required by 30%. Conclusion: We suggest an isosceles triangle between the instruments with an angle between 25 degrees and 45 degrees and an angle of <55 degrees between the instruments and the horizontal line as the optimal geometry for intracorporeal suturing, These data should be considered when planning a reconstructive laparoscopic procedure (i.e., alignment of trocars, table position). However, further studies are required to confirm these preliminary results.
引用
收藏
页码:191 / 198
页数:8
相关论文
共 42 条
  • [1] Albala D M, 1992, Semin Urol, V10, P222
  • [2] LAPAROSCOPIC ASSISTED CONTINENT URINARY-DIVERSION IN THE PIG
    ANDERSON, KR
    FADDEN, PT
    KERBL, K
    MCDOUGALL, EM
    CLAYMAN, RV
    [J]. JOURNAL OF UROLOGY, 1995, 154 (05) : 1934 - 1938
  • [3] AROM KV, 1997, ANN THORAC SURG, V63, P48
  • [4] SPECIAL CONSIDERATIONS IN THE TECHNIQUE OF LAPAROSCOPIC URETEROLITHOTOMY
    BELLMAN, GC
    SMITH, AD
    [J]. JOURNAL OF UROLOGY, 1994, 151 (01) : 146 - 149
  • [5] BRUNE IB, 1992, CHIRURG, V63, P577
  • [6] CLAYMAN RV, 1993, LAPAROSCOPIC UROLOGY, P66
  • [7] AN INITIAL COMPARATIVE-STUDY OF 2 TECHNIQUES OF LAPAROSCOPIC COLONIC ANASTOMOSIS AND MESENTERIC DEFECT CLOSURE
    COHEN, SM
    CLEM, MF
    WEXNER, SD
    JAGELMAN, DG
    [J]. SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, 1994, 8 (02): : 130 - 134
  • [8] LAPAROSCOPIC ANTIREFLUX SURGERY AND REPAIR OF HIATAL-HERNIA
    CUSCHIERI, A
    [J]. WORLD JOURNAL OF SURGERY, 1993, 17 (01) : 40 - 45
  • [9] Ehrlich Richard M., 1993, Journal of Endourology, V7, pS140
  • [10] Frede T., 1997, Journal of Endourology, V11, pS54