Force Comparison of Commercially Available Transfascial Suture Passers.
BACKGROUND
Transfascial suture passers (TSPs) are a commonly used surgical tool available in a wide array of tip configurations. We assessed the insertion force of various TSPs in an ex vivo porcine model.


METHODS
Uniform sections of porcine abdominal wall were secured to a 3D-printed platform. Nine TSPs were passed through the abdominal wall both without and with prolene suture under the following scenarios: abdominal wall only and abdominal wall plus underlay ePTFE or composite ePTFE/polypropylene mesh. Insertion forces were recorded in Newton (N).


RESULTS
When passed without suture through the abdominal wall, smaller diameter TSPs required less insertional force (1.50 ± 0.17 N vs 9.68 ± 1.50 N [ P = 0.00072]). Through composite mesh, the solid tipped TSPs required less force than hollow tipped ones (3.87 ± 0.25 N vs 7.88 ± 0.20 N [ P = 0.00026]). Overall, smaller diameter TSPs required less force than the larger TSPs when passed through ePTFE empty (Gore 2.95 ± 0.83 N vs Carter-Thomason 16.07 ± 2.10 N [ P = .0005]) or with suture (Gore 8.37 ± 2.59 N vs Carter-Thomason 19.12 ± 1.10 N [ P = .003]).


CONCLUSIONS
Diameter plays the greatest role in the force required for TSP penetration. However, when passed through underlay mesh or while holding suture, distal tip shape, the mechanism of suture holding, and shaft diameter all contribute to the forces necessary for penetration. These factors should be considered when choosing a TSP for intraoperative use.
1 The Pennsylvania State University, Hershey, PA, USA.
Alexander J
AJ
Shope
1 The Pennsylvania State University, Hershey, PA, USA.
Joshua S
JS
Winder
1 The Pennsylvania State University, Hershey, PA, USA.
Jonathan T
JT
Bliggenstorfer
1 The Pennsylvania State University, Hershey, PA, USA.
Kristen T
KT
Crowell
1 The Pennsylvania State University, Hershey, PA, USA.
Randy S
RS
Haluck
1 The Pennsylvania State University, Hershey, PA, USA.
Eric M
EM
Pauli
D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D004867:Equipment Design; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D008422:Materials Testing / Q000295:instrumentation; D055595:Mechanical Phenomena; D011126:Polypropylenes / Q000627:therapeutic use; D066330:Printing, Three-Dimensional; D012107:Research Design; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013552:Swine
D011126:Polypropylenes
hernia; laparoscopy; mesh; suture passer; transfascial