Laparoscopic Surgery Procedures Research Articles

Postlaparoscopic Iatrogenic Pseudoaneurysms of the Arteries of the Peritoneal and Retroperitoneal Space

Laparoscopic surgery procedures are associated with a low percentage of cases of iatrogenic traumatic laceration of the arteries of the peritoneal and retroperitoneal space. These lesions rarely lead to pseudoaneurysm formation. In 1 case, we performed a meta-analytic review of the literature on postlaparoscopic iatrogenic pseudoaneurysms focusing on specific parameters: (1) artery involved, (2) type of laparoscopic operation, (3) time interval between the laparoscopic operation and the final diagnosis of the pseudoaneurysm, (4) clinical presentation, (5) diagnostic tools used, (6) mode of treatment applied, and (7) clinical outcome. We searched Medline for pseudoaneurysms developing as complications of laparoscopic procedures. The search terms used were "iatrogenic pseudoaneurysm," "complications after laparoscopic procedures," "traumatic arterial laceration," "pseudoaneurysm formation," and "postoperative hematoma" in various combinations. A total of 66 cases were retrieved. Postlaparoscopic iatrogenic pseudoaneurysms are late manifestations of arterial complications developing during routine laparoscopy. There are 66 reported cases of this type of complication in the literature. The majority occurs in the arteries of the operation field of the respective laparoscopic procedure. Distal vessels are involved less frequently. They usually present after a mean period of approximately 6 weeks. The hepatic and renal arteries are usually affected. The clinical picture includes upper and lower gastrointestinal bleeding, diffuse or localized abdominal pain, hematuria, and drain bleeding.

How to use laparoscopic surgical instruments safely

The development of laparoscopic surgery has been accompanied by a rapid increase in the number of laparoscopic surgical procedures carried out in the field of urology. In 2002 laparoscopic nephrectomy was approved for coverage under Japanese national health insurance, and in 2003 there were over 1000 registered cases in which this procedure was carried out. This suggests that laparoscopic nephrectomy, a procedure formerly conducted at only a few institutions, is now spreading to hospitals across Japan. Laparoscopic surgery involves the use of specialized instruments within a restricted field of vision, and risky surgical techniques can potentially result in visceral or vascular damage. In order to promote the use of safe laparoscopic surgery procedures, the Japanese Urological Association and the Japanese Society of Endourology and Extracorporeal Shock Wave Lithotripsy (ESWL) have inaugurated a certification program for urologic laparoscopy. This program not only encourages development in this field of surgery and provides technical certification to ensure appropriate levels of expertise, but also reviews methods for the correct use of instruments such as trocars and hemostats. The purpose of this video is to present correct methods for the use of a variety of laparoscopic instruments, in order to increase the safety of this procedure. The video has been designed to be useful not only for practitioners who are just beginning laparoscopy, but also for those who already have extensive laparoscopic experience. The video discusses five laparoscopic instruments (trocar, electric surgical devices, ultrasonic surgery devices, clips and clip appliers and endo-staplers), and demonstrates their correct use. In addition, animal models are used to illustrate the potential complications that can be associated with some methods of use.

New Practical Course for Laparoscopy Training: Anatomizing the Orange

Purpose: The aim of this study was to evaluate whether anatomizing the orange reliably improves laparoscopic skills and can therefore be used as a course in laparoscopic surgical training. Materials and Methods: 12 trainees were required to practice baseline laparoscopic skills for 10 days and were then randomized into groups: 6 people who anatomized the orange for 1 h daily for 5 days and 6 in a control group who continued to practice the baseline laparoscopic skills. The trainees were tested on completing porcine laparoscopic nephrectomy. Operative performance was measured using a global assessment scale of surgical skill. Results: The total score of global rating scale was 23.4 ± 4.1 for the group who anatomized the orange and 18.3 ± 2.7 for the control group (p < 0.05). Operative performance significantly improved in the group anatomizing the orange. Conclusion: Anatomizing the orange resulted in improving laparoscopic skills and can be incorporated into the laparoscopic training course. This could be beneficial for those who wish to develop the advanced skills required for various laparoscopic surgery procedures.

Absence of the celiac trunk: Case report and review of the literature

The authors report a rare variation of the absence of the celiac trunk in a Japanese cadaver, with the left gastric, splenic, common hepatic, and superior mesenteric arteries arising independently from the abdominal aorta in the routine dissection of a 95-year-old Japanese male cadaver. The incidence and developmental and clinical significance of this variation is discussed with a detailed review of the literature. Knowledge of such case has important clinical significance in an abdominal operation or invasive arterial procedure, that is, Appleby procedure and liver transplantation, laparoscopic surgery, and radiological procedures in the upper abdomen.

Preliminary Experience Using a Computer-mediated Flexible Circular Stapler in Laparoscopic Esophagogastrostomy

Intracorporeal esophagogastrostomy after laparoscopic proximal gastrectomy is technically challenging. We employed a computer-mediated flexible circular stapler (SurgASSIST) for esophagogastrostomy in 2 cases with gastrointestinal stromal tumor located near the esophagogastric junction. Esophagogastrostomy was successfully constructed intracorporeally using the double-stapling technique. Operation times for the 2 cases were 225 and 170 minutes. No anastomotic leakage was encountered. However, anastomotic stricture requiring balloon dilatation occurred in 1 patient. The SurgASSIST system was feasible for esophageal anastomosis in laparoscopic proximal gastrectomy. However, the digital loading unit (DLU) is too large to introduce transorally, and attempting introduction of the DLU through the narrow lumen may create lesions or perforate the organ. Further improvements in the DLU will facilitate wider use of this system for various procedures in laparoscopic surgery.

Simulation-Based Training: The Next Revolution in Radiology Education?

Simulation-based training methods have been widely adopted in hazardous professions such as aviation, nuclear power, and the military. Their use in medicine has been accelerating lately, fueled by the public's concerns over medical errors as well as new Accreditation Council for Graduate Medical Education requirements for outcome-based and proficiency-based assessment methods. This article reviews the rationale for simulator-based training, types of simulators, their historical development and validity testing, and some results to date in laparoscopic surgery and endoscopic procedures. A number of companies have developed endovascular simulators for interventional radiologic procedures; although they cannot as yet replicate the experience of performing cases in real patients, they promise to play an increasingly important role in procedural training in the future.

Effects of Preoperative Massage on Intra- and Postoperative Outcomes

The aim of this study was to investigate the effects of preoperative massage on intra- and postoperative outcomes in 105 female subjects who had a laparoscopic gynecologic surgery procedure done. T...

Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy

Laparoscopic management of nonobstetric acute abdominal pain during pregnancy remains controversial. A gestational age of 26 to 28 weeks has been considered the upper limit for laparoscopy by some authors. A case series of nonobstetric surgery in advanced pregnancy is reported. Third-trimester patients who underwent surgery between 1997 and 2006 were reviewed. Laparoscopic surgery was performed for nonobstetric emergencies during the third trimester for 11 patients. Four patients underwent open surgery. The laparoscopic surgery group included five cholecystectomies, four appendectomies, and two adenexal surgeries. The laparoscopic surgery procedure was successfully completed for 10 patients. Of these 10 patients, 9 had no complications and went on to deliver a healthy term infant. One patient went into preterm labor after a laparoscopic appendectomy for perforated acute appendicitis with purulent peritonitis and delivered a viable infant at 34 weeks. Another patient at 29 weeks of gestation underwent a diagnostic laparoscopy for abdominal pain. Adenexal torsion of a large multicystic ovarian mass led to a laparotomy (obstetrician preference) and right salpingo-oophrectomy. Her postoperative course was complicated by an episode of sudden syncope, hypotension, and fetal distress on postoperative day 3. An emergent laparotomy showed hemoperitoneum attributable to bleeding from the ovarian pedicle. A cesarean section delivery of a preterm infant requiring neonatal resuscitation was performed. The open surgery group included four patients. Two of the patients underwent appendectomies at 35 and 33 weeks, respectively, followed by a term delivery. The remaining two patients underwent emergent colectomies with a cesarean section delivery at 31 and 38 weeks, respectively. This study demonstrated that laparoscopic surgery in the third trimester of pregnancy is feasible and can be performed safely with an acceptable risk to the fetus and the mother. Access to the pregnant abdomen is easily obtained. Space generally is not a problem, and there is minimal uterine manipulation.

Transdermal Scopolamine: An Alternative to Ondansetron and Droperidol for the Prevention of Postoperative and Postdischarge Emetic Symptoms

Given the controversy regarding the use of droperidol and the high cost of the 5-HT3 antagonists, a cost-effective alternative for routine use as a prophylactic antiemetic would be desirable. We designed two parallel, randomized, double-blind sham and placebo-controlled studies to compare the early and late antiemetic efficacy and adverse event profile of transdermal scopolamine (TDS) 1.5 mg, to ondansetron 4 mg IV, and droperidol 1.25 mg IV for antiemetic prophylaxis as part of a multimodal regimen in "at risk" surgical populations. A total of 150 patients undergoing major laparoscopic (n = 80) or plastic (n = 70) surgery procedures received either an active TDS patch (containing scopolamine 1.5 mg) or a similar appearing sham patch 60 min before entering the operating room. All patients received a standardized general anesthetic technique. A second study medication was administered in a 2-mL numbered syringe containing either saline (for the two active TDS groups), droperidol, 1.25 mg, or ondansetron, 4 mg (for the sham patch groups), and was administered IV near the end of the procedure. The occurrence of postoperative nausea and vomiting/retching, need for rescue antiemetics, and the complete response rates (i.e., absence of protracted nausea or repeated episodes of emesis requiring antiemetic rescue medication) was reported. In addition, complaints of visual disturbances, dry mouth, drowsiness, and restlessness were noted up to 72 h after surgery. There were no significant differences in any of the emetic outcomes or need for rescue antiemetics among the TDS, droperidol, and ondansetron groups in the first 72 h after surgery. The complete response rates varied from 41% to 51%, and did not significantly differ among the treatment groups. The overall incidence of dry mouth was significantly more frequent in the TDS groups than in the droperidol and ondansetron groups (21% vs 3%). Premedication with TDS was as effective as droperidol (1.25 mg) or ondansetron (4 mg) in preventing nausea and vomiting in the early and late postoperative periods. However, the use of a TDS patch is more likely to produce a dry mouth.

Hepatectomia por videolaparoscopia: realidade?

RACIONAL: Apesar do grande avanço nos últimos anos, a ressecção hepática é uma das últimas fronteiras a serem vencidas pela cirurgia laparoscópica. As publicações na literatura mundial referem-se a relatos de casos ou avaliação de pequenas séries de pacientes que são vistas com ceticismo por muitos cirurgiões. Trata-se de procedimento difícil e longo para o qual são necessários experiência em cirurgia hepática e laparoscópica, além de equipamento adequado. Foram avaliadas as indicações e os aspectos técnicos, realizando-se análise crítica do método. CONCLUSÃO: Analisando-se os resultados de artigos publicados, pode-se concluir que a hepatectomia por videolaparoscopia é hoje operação segura e factível e portanto, uma realidade, tendo no entanto, indicação para casos selecionados. A ressecção hepática por laparoscopia deve fazer parte do armamentário terapêutico do cirurgião de fígado.

Advantages of ProSeal™ and SLIPA™ airways over tracheal tubes for gynecological laparoscopies

To compare the efficacy of the ProSeal LMA and SLIPA supralaryngeal airways (SLA) with the standard tracheal tube (TT) in 150 consecutive day-case laparoscopic gynecological surgery procedures requiring general anesthesia.One hundred and fifty patients were randomized into three groups. An identical general anesthesia technique was used in all patients apart from the addition of muscle relaxants and reversal drugs in the TT group. Patients were excluded if there were risk factors for gastroesophageal reflux. Ease of use, quality of seal, ventilation, systolic pressure, response to intubation, side effects and operating room time were assessed.Both ProSeal LMA and SLIPA were easy to insert (100% success) and ventilate with respective mean (standard deviation) maximum sealing pressures of 31 (4.6) and 30 (5.2) cmH2O (P = 0.4) with no muscle relaxants. The seal quality in both ProSeal LMA and SLIPA permitted the use of low flows, 485 (291) and 539 (344) mL x min(-1) (P = 0.2) respectively, although in the TT group significantly lower flows [377 (124) mL x min(-1)], (P < 0.01) were achieved. Systolic pressure in the SLA groups was more stable in response to insertion than in the TT. With ProSeal there was a lower incidence of sore throats than with TT (30% vs 57%), (P < 0.05), but there was a lesser difference as compared with SLIPA (30% vs 49%), (P > 0.05). With both SLAs, there was a significant reduction in operating room time (> three minutes), (P < 0.001).These results suggest that the ProSeal LMA (reusable) and SLIPA (single-use) SLAs were easy to use without requiring muscle relaxants, and reduce operating room time compared to the TT technique in day case laparoscopies.

A Comparison of State and Response Entropy Versus Bispectral Index Values During the Perioperative Period

Cerebral monitoring indices are associated with a large degree of inter-patient variability and electrical signal interference during surgery. We designed this clinical study to test the hypothesis that use of the spectral entropy (Entropy) module is associated with less frequent intraoperative interference with the displayed indices than the bispectral index (BIS) monitor when used during general anesthesia with propofol and desflurane. Thirty consenting patients scheduled for major laparoscopic surgery procedures were enrolled in this prospective study. The elapsed time to obtain a baseline index value was recorded, as well as the simultaneous state entropy (SE), response entropy (RE), and BIS values at specific time intervals during the induction, maintenance, and emergence periods in patients administered a standardized general anesthetic technique. During the maintenance period, the changes in these indices were evaluated after a bolus dose of propofol (20 mg IV) and a 2% increase or decrease in the inspired concentration of desflurane. As expected, the baseline SE values were less than the RE and BIS values (88 +/- 2 versus 96 +/- 3 and 96 +/- 4, respectively). However, the SE and RE values correlated with the BIS value during the induction (r = 0.77 and 0.78, respectively) and emergence (r = 0.86 and 0.91, respectively) periods. The area under the receiver operating characteristic curve for detection of consciousness also indicated a similar performance of the SE (0.93 +/- 0.04) relative to the RE (0.98 +/- 0.04) and BIS (0.97 +/- 0.04). During the maintenance period, the responses to changes in propofol and desflurane concentrations were consistent with all three indices. Finally, the entropy indices were less interfered with by the electrocautery unit during the operation (12% versus 62% for the BIS monitor). Because the average selling prices of the Entropy and BIS disposable electrode strips (14.25 dollars versus 14.95 dollars USD, respectively) are comparable, we conclude that the Entropy module is a cost-equivalent alternative to the BIS monitor.

TU‐FF‐A4‐02: Active Tool/Fiducial Segmentation and Tracking in Multiple Modalities

Purpose: To build a tracking framework that, given a description of a tool/fiducial, the geometry of the imaging system and a sequence of images, outputs estimates of selected kinematics of the tool/fiducial along with a measure of the uncertainty in these estimates. The output of the system may be used as feedback to actively modify the imaging system parameters in order to achieve the desired precision with which the object is tracked while minimizing other parameters (eg. dose delivered to the patient). Method and Materials: A two stage approach is employed where (i) the object is segmented using its invariant features, its model, and other prior information that may be available and (ii) a particle filter is applied to the results of the segmentation for robustly tracking the object. A particle filter is chosen because of its simplicity, its robustness to noise and occlusion, its ability to represent multimodal beliefs, and also because its performance approaches that of the optimal Kalman filter given enough samples. Results: This approach has been applied to a (physically) simulated brachytherapy procedure to track the position of a needle loaded with seeds in an X‐ray fluoroscopic sequence. The system outputs the 3D position and orientation of the needle along with a confidence measure along each dimension. This output is robust to noise and partial occlusion. Conclusion: This work provides a generic framework for segmentation and tracking across multiple modalities that also reports a confidence measure for each estimated parameter. Such a system has many online applications such as radiation therapy guidance, intra‐operative image‐guided laparoscopic surgery, brachytherapy and various biopsy procedures.

The synthesis rate of albumin decreases during laparoscopic surgery.

In previous studies, a decline in total liver protein synthesis during elective laparoscopic surgery has been observed. However, when albumin synthesis was measured in parallel no apparent influence of the procedure was detected. The aim of the present study was to specifically investigate the effect of a laparoscopic procedure on albumin synthesis. Female (n = 9) patients scheduled for elective laparoscopic cholecystectomy as a consequence of cholecystolithiasis were investigated. The fractional synthesis rate (FSR) of albumin was investigated twice in each patient, before and during surgery (2-3 h apart), employing L-[2H5]phenylalanine and gas chromatography mass spectrometry. The FSR of albumin decreased from 7.3 +/- 1.2% per day before surgery to 6.2 +/- 1.4% per day during the procedure (P<0.01), whereas the corresponding absolute synthesis rates of albumin decreased from 114 +/- 24 to 86 +/- 16 mg kg(-1) day(-1), respectively (P<0.001). In conclusion, the synthesis rate of albumin decreased during a laparoscopic surgery procedure. However, the characteristics for this decrease differ from those previously observed for total liver protein synthesis.

Combined procedures in laparoscopic surgery.

With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 145 combined surgical procedures from January 1999 to December 2002. Of the 145 procedures, 130 were combined laparoscopic/endoscopic procedures and 15 were open procedures combined with endoscopic procedures. The combination included laparoscopic cholecystectomy, various hernia repairs, and gynecological procedures like hysterectomy, salpingectomy, ovarian cystectomy, tubal ligation, urological procedures, fundoplication, splenectomy, hemicolectomy, and cystogastrostomy. In the same period, 40 patients who had undergone laparoscopic cholecystectomy and 40 patients who had undergone ventral hernia repair were randomly selected for comparison of intraoperative outcomes with a combined procedure group. All the combined surgical procedures were performed successfully. The most common procedure was laparoscopic cholecystectomy with another endoscopic procedure in 129 patients. The mean operative time was 100 minutes (range 30-280 minutes). The longest time was taken for the patient who had undergone laparoscopic splenectomy with renal transplant (280 minutes). The mean hospital stay was 3.2 days (range 1-21 days). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 5 with a mean of 3.1. Of 145 patients who underwent combined surgical procedures, 5 patients developed fever in the immediate postoperative period, 7 patients had port site hematoma, 5 patients developed wound sepsis, and 10 patients had urinary retention. As long as the basic surgical principles and indications for combined procedures are adhered to, more patients with concomitant pathologies can enjoy the benefit of minimal access surgery. Minimal access surgery is feasible and appears to have several advantages in simultaneous management of two different coexisting pathologies without significant addition in postoperative morbidity and hospital stay.

Antimicrobial Prophylaxis in Laparoscopic Gynecologic Surgery: A Prospective Randomized Study Comparing Amoxicillin-Clavulanic Acid with Cefazolin

Numerous studies have been published in recent years about antimicrobial prophylaxis in gynecologic surgery, but the optimal drug and schedule for the different surgical procedures is still a matter of debate. The aim of the present study was to compare two ultra-short term antimicrobial prophylaxis regimens (amoxicillin-clavulanic acid and cefazolin) in preventing infections following laparoscopic gynecologic operations. Three hundred sixty women hospitalized for a laparoscopic gynecologic surgery procedure were included in the study between January 1999, and December 2001. Patients were randomly allocated to receive amoxicillin-clavulanic acid (2.2 g) [Group A] or cefazolin (2 g) [Group B] as a single dose 30 minutes before surgery. Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site, urinary tract and respiratory tract. In the amoxicillin-clavulanic acid (Group A) and cefazolin (Group B) groups, overall 164 and 172 patients, respectively, were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both groups with febrile morbidity occurring in only one patient (0.6%) in the amoxicillin- clavulanic group. No sign of infections at the surgical site, urinary tract and respiratory tract was observed in either group. No death due to sepsis was recorded. It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparoscopic gynecologic surgery.

A randomized, placebo controlled, trial of preoperative sustained release Betamethasone plus non-controlled intraoperative Ketorolac or Fentanyl on pain after diagnostic laparoscopy or laparoscopic tubal ligation [ISRCTN52633712

BackgroundGynecological laparoscopic surgery procedures are often complicated by postoperative pain resulting in an unpleasant experience for the patient, delayed discharge, and increased cost. Glucocorticosteroids have been suggested to reduce the severity and incidence of postoperative pain.MethodsThis study examines the efficacy of a sustained release betamethasone preparation to reduce postoperative pain and the requirement for pain relief drugs after either diagnostic laparoscopy or tubal ligation. Patients were recruited, as presenting, after obtaining informed consent. Prior to surgery, patients were randomly selected by a computer generated table to receive either pharmacy-coded betamethasone (12 mg IM Celestone™) or an optically identical placebo injection of Intralipid™ and isotonic saline mixture. The effect of non-controlled prophylactic intraoperative treatment with either fentanyl or ketorolac per surgeon's orders was also noted in this study. Blood samples taken at recovery and at discharge times were extracted and analyzed for circulating betamethasone. Visual analog scale data on pain was gathered at six post-recovery time points in a triple blind fashion and statistically compared. The postoperative requirement for pain relief drugs was also examined.ResultsAlthough the injection achieved a sustained therapeutic concentration, no beneficial effect of IM betamethasone on postoperative pain or reduction in pain relief drugs was observed during the postoperative period. Indeed, the mean combined pain scores during the 2 hour postoperative period, adjusted for postoperative opioids as the major confounding factor, were higher approaching statistical significance (P = 0.056) in the treatment group. Higher pain scores were also observed for the tubal ligation patients relative to diagnostic laparoscopy. Intraoperative fentanyl treatment did not significantly lower the average pain score during the 2 hour postoperative period. Intraoperative ketorolac treatment significantly lowered (P = 0.027) pain scores and reduced the postoperative requirement for additional pain relief drugs.ConclusionsThere was a lack of efficacy of preoperative sustained release betamethasone in reducing postoperative pain despite maintaining a therapeutic concentration during the postoperative period. Intraoperative Ketorolac did afford some short-term pain relief in the postoperative period and reduced the need for additional pain relief drugs.

Robotics in Laparoscopic Surgery: Current Status and Future Perspectives

Background : Laparoscopic surgery has been introduced to limit the burden of surgical damage to the abdominal wall and peritoneum. Methods : Description of procedure and results of robotic laparoscopic surgery. Results : Laparoscopic surgery has resulted in reduction of postoperative pain, surgery-related complications and scarring. Laparoscopic techniques, however, are challenging for the surgeon owing to the disadvantages of inverted and restricted manipulation and the indirect two-dimensional view. In order to solve these problems, robotic telemanipulation systems were developed and introduced to the market at the end of the past decade. This article describes and discusses the current status and future perspectives of robotic systems in endoscopic surgery. Conclusion : Robotic laparoscopic surgery overcomes some of the disadvantages of conventional laparoscopic surgery.

Laparoscopic surgery of endometrial cancer. Preliminary results of a multicentric study

ObjectiveTo analyse the results of laparoscopic management of women with endometrial cancer, and comparison with the open technique.DesignProspective multicentre study.SettingDepartment of Gynaecology, Hospital for Infants, Kladno, Czech Republic.Subjects76 women who underwent laparoscopic surgery and open procedures for endometrial cancer.Main outcome measuresThe differences between both the peri‐ and postoperative outcomes were evaluated.ResultsTwo patients whose surgery was completed by laparotomy were excluded from the study. The other 43 laparoscopic procedures were successfully completed. Laparoscopic hysterectomy and pelvic and para‐aortic lymphadenectomies were carried out, based on the grade of the tumour and the depth of myometrial invasion. Of the patients, 19 underwent pelvic lymphadenectomy and 14 women also had para‐aortic lymph node sampling dissection. Five of these patients had positive pelvic or para‐aortic nodes. The mean operating time was 178 min vs. 151 min in the control open group. There were no major complications.ConclusionsThe laparoscopic approach to surgery for early stage endometrial carcinoma is an attractive alternative to the conventional surgical approach. The advantages of laparoscopic surgery are patient related. Because an abdominal incision is avoided, recovery time is reduced. The major obstacle to incorporating operative laparoscopy into gynaecological oncology is the lack of controlled studies demonstrating its ability to improve current management.

Simplified laparoscopic suturing: an acquired skill

ObjectiveTo describe a simplified method of laparoscopic suturing for advanced or simple laparoscopic surgery by using our specially designed thread carrier, a simple knot and a special knot‐pusher, and to describe a method of making endosutures.DesignProspective study.SettingNational Institute of Laser and Endoscopic Surgery, Mumbai (Bombay), and Jaslok Hospital and Research Centre, Mumbai, India.InterventionsA simplified laparoscopic suturing technique was used in 352 laparoscopic surgery procedures, including laparoscopic hysterectomy, myomectomy, appendectomy, etc.ResultsThe simplified laparoscopic suturing technique designed and used by us is a skill that can be acquired; it is associated with adequate safety, no major complications, and an easy learning curve. It is a cheap technique and not dependent on a continuous supply of ready‐made endosutures.ConclusionThough laparoscopic surgery has progressed rapidly, suturing techniques still remain difficult and quite often confusing. We have designed a simplified suturing technique for various laparoscopic surgery procedures, which is elegant, secure and cheap, which is easy to learn and is associated with no major complications. Our technique is predominantly extracorporeal; however, the simplification of both extracorporeal and intracorporeal suturing will be of benefit to all endoscopists.