New laparoscopic suturing device: initial clinical experience.
OBJECTIVE
New instrumentation and techniques have enabled laparoscopic surgeons to perform complicated reconstructive procedures. Few centers have attempted these procedures because of the excessive time involved with laparoscopic suturing. The Endo stitch suture device was developed to facilitate suture placement. We clinically compared conventional intracorporeal suturing and Endo Stitch suturing for laparoscopic suture placement and knot tying.


METHODS
Intracorporeal suturing was used to complete laparoscopic dismembered pyeloplasties and bladder neck suspensions. Sutures were placed with either needle holders and graspers or the automatic suture device. A total of 85 maneuvers were assessed. Operative videotapes were reviewed to assess accuracy of suture placement, knot tying, and time to place suture and tie knots. All suturing was performed by an experienced laparoscopist.


RESULTS
Accuracy of stitch placement and knot tying were equivalent. The average time for stitch placement with the Endo Stitch was 43 +/- 27 seconds (n = 41). This was significantly less than the average stitch placement time for conventional suturing, which was 151 +/- 24 seconds (n = 14). The Endo Stitch knot tying was completed in an average of 74 +/- 50 seconds (n = 17), whereas knot tying with the conventional technique took 197 +/- 70 seconds (n = 13). The needle is automatically loaded in the Endo Stitch after each suture and is immediately ready.


CONCLUSIONS
The Endo Stitch device reduced the amount of time needed for placement of stitches and knot tying. Reconstructive laparoscopic procedures requiring multiple suture placement may be completed in a shorter time period using this instrument.
Adams
J B
JB
Brady Urological Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224.
Schulam
P G
PG
Moore
R G
RG
Partin
A W
AW
Kavoussi
L R
LR
D004867:Equipment Design; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery; D020706:Laparoscopes; D009339:Needles; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery