title: Suture damage during robot-assisted vascular surgery: is it an issue?
abstract: BACKGROUND
  Manipulation of sutures during endoscopic surgery could lead to damage of suture structure, supposedly resulting in loss of strength. Lack of tactile feedback in robotic surgical systems might increase this problem. The objective of this study is to evaluate suture strength after robotic manipulation and to determine which suture material is least susceptible to damage from robotic manipulation.
  
  
  METHODS
  The da Vinci surgical system was used to manipulate sutures. Three different suture materials (Prolene, ePTFE, Ethibond) of 3 different sizes (3-0, 4-0, and 5-0) were tested. A total of 270 sutures were pulled on a Servohydraulic Universal Testing Machine. The frequency of breaks at a manipulation-point and the maximum applied force (N) before the suture broke were used for statistic analysis.
  
  
  RESULTS
  No loss in strength was shown in the ePTFE sutures after manipulation, whereas both Prolene and Ethibond sutures showed a significant loss of strength.
  
  
  CONCLUSIONS
  ePTFE sutures are least susceptible to robotic manipulations and are, therefore, to be considered as a material of first choice.
authors: Department of Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
authors: Jeroen
authors: J
authors: Diks
authors: Denise
authors: D
authors: Nio
authors: Matteus A
authors: MA
authors: Linsen
authors: Jan A
authors: JA
authors: Rauwerda
authors: Willem
authors: W
authors: Wisselink
mesh_terms: D004868:Equipment Failure; D008422:Materials Testing; D011093:Polyethylene Terephthalates; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D012371:Robotics; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013536:Suture Techniques / Q000009:adverse effects* / Q000295:instrumentation*; D013537:Sutures; D013718:Tensile Strength; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: C014534:Ethibond; D011093:Polyethylene Terephthalates; D011126:Polypropylenes; D011138:Polytetrafluoroethylene