title: Intracorporeal suturing and knot tying broadens the clinical applicability of laparoscopy.
abstract: OBJECTIVE
  As surgeons become more experienced with basic laparoscopic procedures like cholecystectomy, they are able to expand this approach to less common operations. However, without laparoscopic suturing skills, like those obtained with Nissen fundoplication, many operations cannot be completed laparoscopically. We present a series of 10 patients with less common surgical illnesses who were successfully treated with minimal access techniques and intracorporeal suturing.
  
  
  METHODS
  Over a 6-month period at 2 medical centers, 10 patients underwent operations with laparoscopic intracorporeal suturing and knot tying. Diagnoses included bowel obstruction due to gallstone ileus (n=1), perforated uterus from an intrauterine device (n=1), urinary bladder diverticulum (n=1), bleeding Meckel's diverticulum (n=3), and perforated duodenal ulcer (n=4).
  
  
  RESULTS
  Each patient was treated with standard surgical interventions performed entirely laparoscopically with intracorporeal suturing. No morbidity or mortality occurred in any patient due to the operation.
  
  
  CONCLUSIONS
  Although each of these operations has been previously reported, as a series, they point out the importance of mastering laparoscopic suturing. Although devices are commercially available to facilitate certain suturing scenarios, we encourage residents and fellows to sew manually. We believe that none of these operations could have been completed as effectively by using a suture device. The ability to suture laparoscopically markedly broadens the number of clinical scenarios in which minimal access techniques can be used.
authors.affiliation: Department of Surgery, University of Louisville, Kentucky 40292, USA. jeffa@iglou.com
authors.forename: Jeff W
authors.initials: JW
authors.lastname: Allen
authors.forename: Homero
authors.initials: H
authors.lastname: Rivas
authors.forename: Robert N
authors.initials: RN
authors.lastname: Cocchione
authors.forename: George S
authors.initials: GS
authors.lastname: Ferzli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation