51 Laparoscopic suturing: effect of instrument handling on suture strength

Abstract

Introduction: The limited operative field of laparoscopic surgery necessitates repeated instrument handling of suture material, which is discouraged in conventional open surgery. The quantitative effect of instrument handling on suture material has not previously been investigated. The aim of this study was to assess the effect of instrument trauma on various suture materials by laparoscopic needle holders and forceps.Materials and Methods: Three sutures of various gauge and material, 2‐0 and 3‐0 Polyglactin 910 and 2‐0 Poliglecaprone 25, commonly used in laparoscopic urological reconstruction, were tested. Controlled damage was performed by grasping the suture without tension between the jaws of either a toothed laparoscopic grasping forceps or a laparoscopic needle holder. Physical testing was performed using an Instron 5564 computer controlled tensile testing, which measured suture extension and tensile strength. Samples were examined using scanning electron microscopy.Results: There was no difference in mean percentage extension or tensile strength when comparing suture types damaged with laparoscopic graspers and controls regardless of their gauge or material. Following controlled damage with laparoscopic needle holders, % extension of damaged sutures was significantly lower compared with undamaged sutures. Tensile strength was significantly lower for 3‐0 Vicryl and 3‐0 Monocryl after damage with laparoscopic needle holders compared with undamaged sutures, but not 2‐0 Vicryl.Conclusion: The handling of suture material with laparoscopic instruments, especially needle holders, results in surface damage to the suture, which impacts on the suture mechanics. Limiting surface damage to suture material requires careful technique, avoiding shear force, minimising handling of the suture, and using shorter suture lengths.