Laparoscopic Suturing And Knotting Mob: 7289915430, www.drpradeepgarg

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Laparoscopic Suturing And Knotting Mob: 7289915430, www.drpradeepgarg

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Laparoscopic Suturing And Knotting Mob: 7289915430, www.drpradeepgarg

  1. 1. Laparoscopic Suturing And Knotting Dr. Pradeep Kumar Garg Assistant Professor Department of Obstetrics & Gynaecology AIIMS, New Delhi Email:pkgarg_in2004@yahoo.com
  2. 2. <ul><li>To see videos on laparoscopic gynae surgeries please logon to www .youtube.com </li></ul><ul><li>and type Pradeep aiims </li></ul>
  3. 3. Port Placement
  4. 4. Ipsilateral Suturing <ul><li>Advantages of Ipsilaeral </li></ul><ul><li>Less fatigue </li></ul><ul><li>More useful for surgeries like myomectomy where more numbers of sutures are usually taken </li></ul>
  5. 5. Ipsilateral Suturing
  6. 6. Contralateral Suturing <ul><li>More fatigue </li></ul><ul><li>Obstructs the assistant and camera movements </li></ul><ul><li>Waste of one port and assistants hand </li></ul>
  7. 7. Contralateral Suturing
  8. 8. Our preference in Suturing <ul><li>Ipsilateral intracorporeal suturing for ligating uterine arteries and vault closure in cases of TLH, myomectomy, tunboplasty mesh fixation in cases of vault prolapse, repair of bladder, bowel. </li></ul>
  9. 9. Needle holders <ul><li>Light weight </li></ul><ul><li>Sand blasted i.e. nonreflecting surface </li></ul><ul><li>Optimum width/breadth of the jaw is neither too wide nor too pointed </li></ul><ul><li>Deep cirsscross serrations on the grasping surface of the jaws </li></ul><ul><li>The jaws that is grasping portion of the needle holder should be in line with the long axis of the barrel of the instrument. </li></ul><ul><li>Handle should have less ratchets / catch. </li></ul>
  10. 10. Suture Material <ul><li>Suture length ? </li></ul><ul><li>Vicryl is preferred over the monofilament suture material </li></ul><ul><li>Memory? </li></ul><ul><li>Excellent knotting property </li></ul><ul><li>Gortex – Monofilament, good sliding, less memory </li></ul><ul><li>Monofilament – Ethibond, PDS, Monocryl </li></ul>
  11. 11. Use of pelvic trainers and simulators to teach endoscopic suturing <ul><li>Type : 1. Box trainers, 2. VR trainers </li></ul><ul><li>Box trainers : </li></ul><ul><li>Significantly cheaper </li></ul><ul><li>Authentic instrument to which he she is accustomed, same feel and shape </li></ul><ul><li>True force feedback as they are physical objects </li></ul><ul><li>Allows for leaning the characteristics of various type of knots as well as suture material </li></ul><ul><li>Disadvantage Actual needle and suture material is required. </li></ul>
  12. 12. <ul><li>For queries mail me at </li></ul><ul><li>[email_address] </li></ul>

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