Laparoscopic suturing

The ability to suture laparoscopically increases a laparoscopist's versatility. Suturing is used for hemostasis and to oppose tissues during reconstructive procedures. Different types of sutures are available for endoscopic use. The Endoloop (Ethicon) suture, a preformed slipknot attached to a rigid, disposable 5-mm applicator, is available in 0-chromic gut, polyglactin, polydioxanone, and polypropylene (Figure 5.1). The loop is positioned around the pedicle by grasping the structure to be removed and pulling it through the loop. The loop is tightened against the applicator, and the suture is cut with scissors or the laser beam against a backstop. Suture material is available with a straight or curved swaged needle specifically designed for laparoscopic use. It is available in 0-chromic catgut, 4-0 polydioxanone with a swaged ST-4 needle (PDS, Ethicon), and polyglactin. The suture is grasped with forceps several centimeters from the needle. The grasper with suture is inserted intra-abdominally through the 5-mm accessory trocar sleeve. To place the needle intra-abdominally, the grasper or needle driver is removed along with the trocar sleeve, which remains around the grasper's shaft. The suture is grasped about 5 cm from the needle, and the grasper is reintroduced with the trocar sleeve into the suprapubic incision site.