Modified Needle Holder and Undermining Scissors With Integrated Rulers to Streamline Mohs Reconstruction.

Evidence-Based Guidelines for Instrument and Handle Selection for Ergonomic Optimization in Laparoscopic Surgery.

ObjectiveThis study evaluated a series of 4 weekly, two-hour suture clinics taught using near-peer instruction by trained second year medical students for peer participants at the University of Louisville School of Medicine using a repeated cross sectional mixed-methods study design.MethodsSeven second year medical student instructors were trained and supervised in providing basic technical skills in suturing by a surgical faculty member (Dr Kasdan). Participants in the suture clinic consisted of 48 second year medical student peers who completed a pre- and post-clinic survey evaluating their interest in surgery, as well as their self-efficacy and confidence in performing basic suture skills. Paired-sample t-tests examined self-perceived changes in participants’ skills, confidence, and interest from pre- to post-clinic sessions.ResultsQuantitatively, student participants showed strong improvement in their knowledge of using the needle driver and suture correctly as well as an understanding of when to use a hand tie versus an instrument tie. In addition, confidence in surgical handwashing, gowning, and gloving improved significantly. Knot tying also showed significant improvements, with the most striking improvements in the ability to perform “Fast-Passes” without excessive movement and “Cross-Passes.” The ability to take symmetrical bites on the suturing block also showed considerable improvement, as well as the ability to perform a simple interrupted knot. Overall, participants’ interest in surgery increased significantly following the suture clinic experience. Qualitatively, student participant responses were analyzed in response to a prompt regarding the impact of the suture clinic experience on student interest in surgery, self-efficacy, and confidence. Thematic analysis highlighted students’ lack of experience, safety, and proficiency of technique.ConclusionIn sum, the results of this study support the use of near peer teaching in enhancing self-reported student confidence and performance regarding basic surgical skills in advance of clerkship training.

Introduction: 3D printing technology has demonstrated great efficacy in ad hoc manufacturing of surgical supplies such as needle drivers, forceps, and tissue suture materials. 3D printed nylon sutures manufactured using a fused deposition modeling (FDM) 3D printer exhibited multiple advantages over commercial nylon and polybutester suture materials, including higher ultimate tensile strength and ultimate extension. A mouse model study was conducted to evaluate the healing of laceration wounds repaired using 3D printed nylon suture compared to commercial polybutester (Novafil) suture. Methods: The 3D printed sutures were manufactured using Ultimaker S3 FDM printers and nylon filament, then sterilized using ethylene oxide sterilization. Twenty mice were included in the study, each receiving a 2 cm dermal laceration along their back. Ten mice had their lacerations repaired with simple interrupted 3D printed nylon sutures, and ten with simple interrupted polybutester sutures. All mice underwent daily wound assessments for 7 days, followed by euthanasia and harvesting of local tissue around the laceration site for objective measurement of inflammatory response via FlowJo analysis of F4/80+/80+&CD45+ macrophages and cytokine array. Results: No wound complications, such as dehiscence or infection, were observed in either group. The mean CD45+&F4/80+ macrophage (%) for 3D printed and polybutester sutures was 29.3 and 27.7 (p=0.59, from 2 two sample t-tests), resulting in no statistically significant difference. Additionally, there was no significant difference in tissue inflammation when evaluating cytokine response. Conclusion: Data from this study suggests no difference in wound healing, infection, or inflammatory response between 3D printed nylon and polybutester sutures. The cost of manufacturing 3D-printed suture materials is significantly lower compared to the per-unit pricing of commercial suture materials. Furthermore, 3D printers provide the agency to produce critical supplies on an ad hoc basis with potential applications in low-resource medical scenarios such as rural/developing regions, war zones, or refugee encampments.

BackgroundWe investigated the difference in the extracted surfaces between extractions carried out using forceps and a needle holder, focusing on needle extraction manipulation for smaller needle-hole defects.MethodsIn this prospective observational study, we included patients who underwent aortic surgery at our Hospital between December 2023 and January 2025. Aortic wall samples were collected from the patients with acute type A aortic dissection (n = 20) and thoracic aortic aneurysm (n = 20). Two hundred needle holes were created in the samples from each disease type and randomized into two groups: the forceps (n = 100) and needle holder (n = 100) groups. The long axis, short axis, and area of needle-hole defects were measured and compared between the two groups.ResultsOverall, the long axis in the needle holder group was significantly shorter than that in the forceps group (forceps: 0.52 ± 0.18 vs. needle holder: 0.48 ± 0.12 mm, P = 0.036). The short axis was not significantly different between the groups (forceps: 0.26 ± 0.07 vs. needle holder: 0.25 ± 0.06 mm, P = 0.223). The defect area in the needle holder group was significantly smaller than that in the forceps group (forceps: 0.11 ± 0.06 vs. needle holder: 0.09 ± 0.03 mm2, P = 0.022). Acute aortic dissection showed a similar tendency, whereas thoracic aortic aneurysm showed no significant differences.ConclusionsThe defect area formed when using a needle holder tended to be smaller than that when using forceps, especially in acute aortic dissection. When performing anastomotic pullouts in fragile aortic walls, using a needle holder may help reduce bleeding and prevent distal anastomotic new entry tears.

The intraoperative loss of suture needles can prolong procedures and compromise safety, often occurring when a needle holder is unintentionally dropped and opens. This study explored the mechanism of needle loss through a nationwide survey, controlled drop simulations, and finite element analysis. Among 3649 OR nurses surveyed, 75.4% identified instrument transfer-specifically dropping the needle holder onto the instrument table-as the most common cause of loss. In 1500 simulated drops, unexpected opening occurred in 30.6% of cases, primarily when the holder landed flat or on its ring. Finite element analysis revealed that impact-induced clamp ring deformation displaces locking teeth beyond their biting depth, triggering release. Larger, heavier holders increased both opening risk and needle flight velocity. Design modifications, such as reinforcing the clamp ring and deepening locking teeth, along with cushioned surfaces, may reduce loss events and improve perioperative safety.

Titanium and its alloys have excellent mechanical and biocompatibility features, which are commonly utilized in the production of surgical instruments, such as scalpels, surgical tweezers, needle holders, etc. However, lacking antibacterial ability, titanium materials are susceptible to bacterial infection, which hinders the success of surgical operations. Medical titanium substrates were modified using polydopamine (PDA) coatings in this study, followed by cadmium (Cd) and copper (Cu) ions loaded into the PDA coating to endow titanium surgical instruments with antibacterial properties. The surface topography, chemical state, ion release, and other features of the specimen were analyzed. Additionally, the minimum inhibitory concentration and minimum bactericidal concentration of Cd and Cu ions againstStaphylococcus aureus(S. aureus) andEscherichia coli(E. coli) were quantitatively determined through serial dilution methodology. The antibacterial features of embellished substrates were investigated against bothS. aureusandE. coli. The results demonstrated that the dual-ions (Cd/Cu) modified coating exhibits a reduction in ion release compared to the single ion loaded coatings, with Cd ions demonstrating a 95.13% reduction. Furthermore, the antimicrobial ability of the dual-ions (Cd/Cu) modified coating againstS. aureusandE. coliwas superior to the PDA coating, with antibacterial rates of 99.89% and 92.04%, respectively. The Cd/Cu co-modified coating achieves a balance between low ion release and excellent antibacterial activity, providing insights for metal ion loading and the antibacterial modification of titanium surfaces.

This community service program was implemented in the PKK RW 15 area of Meteseh Village, Semarang City, with the aim of increasing the creativity and economic independence of housewives through training in utilizing household waste into recycled products with economic value. The main problems faced by the community are the lack of skills in waste management and the absence of an integrated training program that combines environmental and economic aspects. The implementation method of the activity includes the preparation stage, training implementation, and evaluation. The training was conducted using a learning-by-doing approach, where participants directly practiced making needle holders and souvenirs from waste cloth scraps and packaging bottles. The results of the activity showed a significant increase in participants' understanding and skills. Twenty percent of participants were able to produce at least one recycled product and showed a 32% increase in knowledge based on pre-test and post-test results. Furthermore, this activity succeeded in fostering new entrepreneurial ideas. Mandatory outputs such as journal publications, online media publications, implementation videos, and IPR submissions were all successfully achieved. This program provides tangible benefits in fostering creativity, increasing family economic potential, and reducing the volume of household waste. This household waste utilization training activity is expected to be the first step in building a recycling culture and empowering women's economics in RW 15, Meteseh Village.

Small, unsightly reticular veins are a frequent concern in dermatology clinics. While standard treatments like sclerotherapy are common, they can be complicated by extravasation, long-term hyperpigmentation, and the risk of arterial injection [1]. Furthermore, light-based therapies are often not effective for vessels larger than telangiectasias. We have developed a novel surgical method, which we term angulated needle phlebectomy, which uses a modified hypodermic needle to hook the desired vessels. The technique is as follows: After marking the target veins, multiple punctures are made with an 18G needle. A 23G needle is then bent at its tip to an angle of 90 degrees or more with the use of a needle holder. This “angulated needle” is inserted through a puncture and advanced along the vessel. The needle is then rotated 5–7 times to grab the vein before pulling it out, extracting the vessel (Figure 1). Figure 2 shows two photographs of a representative patient in which the targeted vein was removed, before and 1 week after the procedure. Notably, the procedure left only transient ecchymosis and tiny erythema from needle wounds. There was no observable scar or linear hyperpigmentation, a common side effect from thrombosed veins in sclerotherapy. The technique differs from traditional hook phlebectomy [2] in its usage of the sharp tip of the 23G needle: It pierces the vascular wall multiple times in advancing and rotating parallel to the vessel, providing a stronger grasp than simple vertical hooking. Smaller vessels (0.1–0.5 cm in diameter), often too small and fragile to hook in our practice, become accessible with this technique. The method also eliminates the need for precise intravascular placement and the risk of extravasation and intra-arterial injection associated with sclerotherapy. In clinical practice, this method also greatly facilitates the clearance of residual avulsed veins during hook phlebectomy because of its stronger grasping effect. Due to its small size and limited mechanical hooking strength, the angulated needle technique is not intended for the treatment of larger varicose veins; however, it may be particularly helpful for small reticular veins that are often difficult to engage with standard hook phlebectomy. Its use may also be limited for very small telangiectasias, but removal of the primary feeding reticular vein can still achieve satisfactory cosmetic results. In our clinics, we have used this technique either as a standalone procedure or as an adjunct to hook phlebectomy for small reticular veins, predominantly involving the lower extremities, including the thighs and calves, in several dozen patients. Follow-up ranged from 1 to 4 months. The side effects observed were limited to transient ecchymosis and mild erythema at the needle entry sites, which typically resolved more rapidly than after sclerotherapy, likely due to the absence of residual damaged or thrombosed vessels. No cases of infection, scarring, nerve injury, or persistent hyperpigmentation were observed. This simple, minimally invasive technique can be readily applied in dermatology clinics and serves as a valuable addition to the treatment armamentarium for varicose and reticular veins. Wei-Ming Wu: conceptualization, methodology, formal analysis, writing – original. Ling-Yi Wu: data curation and writing – review and edit. The authors have nothing to report. This study was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided written informed consent in the study. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

To provide a video tutorial describing and demonstrating techniques to improve apposition of the continuous intradermal suture pattern. With owner approval, a female cat undergoing ovariohysterectomy was used for demonstration. To perform the buried continuous intradermal suture pattern, absorbable suture, needle drivers, and forceps are required. During intradermal bites, dermal apposition may be improved by needle positioning that promotes complete engagement of the dermis, backtracking to avoid skipping lengths of dermal tissue, and maintaining tension of the suture line. Exposed or unburied knots may impede incisional healing. Appropriate knot burial is promoted by ensuring correct orientation of knot-forming components and utilizing incisional dead space. Implementation of proper technique may result in improved dermal-to-dermal apposition, which may promote primary-intention healing and improve patient outcomes. The continuous intradermal suture pattern is a common method for surgical skin closure, particularly for elective procedures including ovariohysterectomies and neuters. However, it is a challenging and time-consuming pattern compared to alternative methods for skin closure. Avoiding common mistakes may improve dermal apposition for incisional healing.

Techniques of interventional endoscopy such as implantation of stents, leak closure by clips, or endoscopic suturing can help in reducing risk of an unfavorable outcome for patients with fistulas in the gastrointestinal tract. One method is endoscopic internal drainage (EID), which has been reported to have remarkable success. Because dislocation can reduce success, endoscopic suture techniques have been applied; however, devices could be cumbersome and/or expensive. The purpose of this experimental study was to evaluation the new endoscopic suturing needle-holder SutuArt for fixation of internal drains at a gastric fistula site. This suturing system is a through-the-scope needle-holder, which can be rotated within the working channel 360 degrees and maneuvered with the endoscope tip in many positions. The experiment was performed using an explanted porcine stomach with attached esophagus. Three consecutive running stitches were performed to provide sufficient fixation of the drain at an experimental “fistula” site. Afterward, the force was measured to dislocate the fixed drain. The results of 12 measurements (median duration 23 minutes; range: 19–44) at 6.7 Newton were compared with the reference value of 12 Newton (full-thickness open-stitch), thus withstanding a substantial pulling force. In conclusion, this study demonstrates the conceptual possibility of using an endoscopic needle holder for suture-fixation of a drain. Further clinical investigations are required to establish a full feasibility test of the concept.

Endoscopic full-thickness resection (EFTR) is a minimally invasive technique for gastrointestinal tract resection and suturing; however, no standardized suturing method has been established. Here, we evaluated a novel endoscopic hand-suturing (EHS) technique, termed "endoscopic full-thickness continuous suturing with stay suture" (EFT-CSS), using SutuArt, an EHS needle holder. This method employs a double-ended needle with V-Loc™ 180 suture, enabling continuous full-thickness suturing. Three tests were conducted to compare EFT-CSS with existing methods: Tensile strength test-A 3-cm circular defect in porcine stomach specimens was closed using clip, purse-string suture (PSS), over-the-scope clip (OTSC), and EFT-CSS, each performed thrice. Maximum tensile strength was measured for each closure. Pressure test-A 3-cm circular defect in porcine stomach was closed using OTSC and EFT-CSS, each performed thrice. Air pressure was applied to the defect, and leakage was evaluated underwater. Safety test-A 3-cm circular defect in intestinal models was sutured on an aluminum plate using single- or double-ended needles, each performed thrice. Damage (scratches) on the aluminum plate and suturing time were recorded. EFT-CSS achieved the highest tensile strength (30.57 ± 8.90N) compared with clip (3.69 ± 0.24N), PSS (5.86 ± 0.32N), and OTSC (19.93 ± 2.25N). Leak pressure was significantly higher with EFT-CSS (54.67 ± 7.23mmHg) versus OTSC (30.00 ± 5.00mmHg). Scar area and suturing time were comparable, with reduced scarring observed when using double-ended needles. These results demonstrate that EFT-CSS outperforms conventional methods in strength and safety, offering a promising advancement in EFTR techniques.

Ocular foreign bodies are a common ophthalmic emergency, with metallic objects typically associated with industrial or occupational injuries in adults. In pediatric patients, metallic foreign bodies are considerably rare. Major proportion of ocular foreign bodies in pediatric population are usually organic (e.g wood, dust) or small objects accessible to children. The tarsal conjunctiva is an uncommon site for such injuries. A 5 year old male presented with sudden onset ocular pain, watering and foreign body sensation, after a metallic wire of approximately 5-7 centimetre (cm) length, diameter of 0.5-1 millimetre (mm), with an anterior looped end of 8 mm accidentally penetrated his right eye during play. Eyelid eversion revealed 8 mm of the anterior looped end embedded in the tarsal conjunctiva with the posterior straight end of the wire exposed. Removal was performed under sedation anaesthesia, using slow, sustained, tangential hand maneuvers with a Barraquer’s needle holder and a 25 gauge needle. Post-procedural care involved topical antibiotics, with resolution of symptoms within 48 hours. This case highlights the rarity of toy-related ocular foreign body injuries in young children and the need for timely intervention and a tailored management approach for optimum results. A bladeless approach for removal further reduces the risk of iatrogenic trauma and a significant role in lowering the risk of conjunctival scarring and intra-ocular infections in the future. Our case highlights the importance on strengthening child safety measures towards preventing accidental ocular injuries in the pediatric age group.

A Single Hydraulic Bellows-Based MRI-Safe Robotic Needle Driver Capable of Independent and Coupled Needle Translation and Rotation

Suturing in the narrow endonasal corridor can be technically challenging. For some endonasal procedures, including inverted U-shaped nasopharyngeal flap (IUNF) harvest for cranio-cervical junction exposure, the ability to support meticulous flap resuspension offers clinical utility. Two novel suturing techniques offer promise: (1) use of barbed suture and (2) Durastat dural repair device, obviating the need for knot tying and endonasal needle driver/supination, respectively. Perform subjective and objective evaluation of IUNF resuspension with: (1) running mucosal suturing using endonasal needle driver and barbed, loop suture and (2) interrupted mucosal suturing using the Durastat device in 3 cadaveric heads. A IUNF was created and subsequently resuspended, (1) using a 3-0 monocryl barbed Stratafix with loop and endonasal needle driver. After Stratafix suture removal, (2) resuspension using interrupted sutures with the Durastat, spring loaded device was performed. Repair time was measured objectively. Suture precision was subjectively evaluated. Adequate IUNF resuspension was provided by both methods (3/3). The barbed suture required more procedural time on average (18:59 minutes), than the Durastat system (18:35 minutes). The small Durastat needle often failed to puncture the mucosal flap using spring mechanism alone, indicating that technical modification to increase needle size and spring torque could improve performance. Adequate mucosal resuspension was achieved in all specimens. Stratafix offered greater consistency with needle puncture and similar precision but was more technically challenging compared to the Durastat system. With appropriate technological modifications, the authors believe the Durastat system has greater potential to optimize IUNF resuspension.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10143-025-04068-x.

The Vertical Needle Holder: A Proof-of-Concept Evaluation of a Novel Instrument for Precision Suturing in Confined Surgical Fields.

Conventional Laparoscopic vs Multi-Degree of Freedom Articulating Instruments in Minimally Invasive Surgical Suturing

This article reports on the development and feasibility testing of an MR-safe robotic needle driver. The needle driver is pneumatically actuated and designed for automatic insertion and extraction of needles along a straight trajectory within the MRI scanner. All parts use plastic resins and composite materials to ensure MR-safe operation. A needle could be clamped in the needle carriage using a pneumatically operated clamp. The clamp is designed to be easily attached and detached from the needle driver. Clamps with different opening sizes could accommodate a range of needles from 18 to 22 gauge. To mimic the manual procedure of needle insertion, a pneumatically operated rack-and-pinion mechanism simultaneously translates and rotates the needle carriage along a helical slot. Signal-to-noise ratio (SNR) and 2-D geometric distortion were measured to evaluate the MRI compatibility. Targeting was measured with an electromagnetic tracker. We also evaluated the maximum force that could be generated at the tip of the needle with different clamping pressures using a force sensor. We recorded the maximum percentage change in SNR for multiple configurations of needle drivers as 6.6% and the maximum geometric distortion at 0.24%. The needle driver's mean positioning accuracy for 105 targets at 50mm depth was 2.38 ± 1.00mm in a composite tissue phantom. The angulation error for the straight trajectory was 0.51°, and the mean linear trajectory deviation was statistically negligible. The measured force at the needle tip was 1.17N, 1.6N, and 2.12N at 30, 40, and 50 psi, respectively. This preliminary study showed that the prototype of our robotic needle driver works as intended for the insertion and extraction of the needle. The driver is MR-safe and serves as a suitable platform for MRI-guided interventions.

Redo per-oral endoscopic myotomy: direct septotomy and cardiomyotomy with mucosal closure via endoscopic hand suturing Fig. 3 Selective myotomy was per- formed on the residual muscular septum, extending into the gastric cardia. Fig. 4 Closure of the mucosal entry using absorbable barbed sutures with an endoscopic needle holder. Fig. 5 Complete mucosal closure achieved with six stitches.

Despite the rapid progress of robotic surgery, intelligent object recognition and autonomous computer-assisted interventions continues to face limitations. Algorithms designed for the identification and localization of surgical tool tips are pivotal in augmenting the interactive collaboration between the robotic surgical system and its operator. In the present study, our aim to formulate a strategy proficient in recognizing and pinpointing commonly used surgical tools in robotic surgery. A strategy for object detection was conceptualized and validated across two datasets. The first dataset provided by the Medical Image Computing and Computer Assisted Intervention Society (MICCAI) consisted of 24,695 video clips. The second dataset comprised surgical videos from 35 clinical cases in our clinical center, encompassing a total of 392 video clips with 53,128 images. Our approach employs CSPNeXt as the backbone network, incorporates OSTrack for pseudo-labeling and Kalman filtering for data fusion. Our model is openly accessible on GitHub. In the MICCAI test set, our strategy achieved a mean Average Precision of 0.4669. In the second video test set, the recall rate (RR) and precision rate (PR) for seven types of tools ranged from 79.36% to 99.75% and from 57.65% to 97.35%, respectively. RR and PR of bipolar forceps, needle driver and cautery hook all exceeded 94%. An effective strategy for the recognition of surgical tools and tips was successfully developed and validated. This strategy shows promise in actively supporting surgical procedures and has the potential to alleviate the workload on human operators during future algorithm training.