Extracorporeal Tying Research Articles

Laparoscopic Needle Introducer

The laparoscopic needle introducer is a new instrument designed to introduce into the peritoneal cavity and withdraw from it curved needles of various sizes, using a 5-mm cannula path. The instrument also can be used when suturing to pull the two ends of the suture through the cannula, allowing extracorporeal tying. It was tested on inanimate models using a laparoscopy trainer. Subsequently it was used successfully in different laparoscopic operations on 15 patients.

New multipurpose endoknot device for laparoscopic surgery

Extracorporeal knot tying for the ligation and suture ligation of various structures is becoming more important with the increasing popularity of laparoscopic surgery, especially in complicated cholecystectomies with the need to do intraoperative cholangiography, and in other advanced procedures. We have designed a new multipurpose endoknot device that can be used to: (1) push the knot of a pre-tied loop, (2) facilitate the extracorporeal tying of square knots, and (3) facilitate the suturing of tissues, using either a slip knot or a square knot. The device consists of a simple stainless steel rod with a 3-mm lateral hole at its working end which connects to a 1-mm hole at the tip. The blunt tip lessens the chance of inadvertent injury to the liver and other organs during knot tying. We have used this instrument in laparoscopic cholecystectomy with intraoperative cholangiography, and in laparoscopic hernia repair, colon resection, and thoracoscopic esophagectomy, with great success and with no morbidity attributable to its use.

Anatomic lobectomy of the lung by means of thoracoscopy: An experimental study

We conducted this study in an attempt to investigate whether anatomic lobectomy can be performed through a thoracoscope. Twelve lower (seven left and five right) and six left upper lobectomies were done in 17 pigs weighing 60 to 90 kg. With the use of general anesthesia and one-lung ventilation, a thoracoscope and operating instruments were inserted through four or five trocars. First, the incomplete fissure was bluntly dissected with specially designed cotton-tipped dissectors and divided by an electrocautery spatula or sapphire contact-tip neodymium: yttrium aluminum garnet laser probe. The pulmonary artery and its branches were similarly dissected. Two ligatures were passed around the vessels by endoscopic right-angle clamps and tied by means of an extracorporeal tying technique. The vessels were clipped and divided. In two animals, a hidden branch of the pulmonary artery was inadvertently cut. Bleeding was readily controlled with the dissector until metal clips could be applied. The bronchus was similarly dissected and divided and the proximal stump was closed with sutures. The pulmonary vein was dissected bluntly by the same technique and divided. The excised lobe was placed in a plastic bag and pulled out through one of the trocar holes after the hole had been enlarged to 3 cm. Blood loss was minimal. In conclusion, anatomic lobectomy of the lung by means of thoracoscopy was feasible in the pig.