A robotic suture‐passing device for possible use in SILS and NOTES

Abstract

Background Natural orifice transluminal endoscopic (NOTES) and single incisional laparoscopic surgeries (SILS) have been gaining importance over the last two decades. Due to improper instrumentation, small workspace and the imperceptibility of body structures, suturing and knot‐tying are difficult to perform in both. Methods An intracorporeal suture‐passing device with two manipulator arms is proposed that automatically passes the suture around ducts of up to 7 mm diameter, without additional manipulation of any other surgical instrument, and it can be deployed through a trocar of 3 mm inner diameter. Results The working mechanism was validated by 15 trials, where passing the suture around a phantom tube was tested, and the operating time measured as (34.55 ± 4.55) seconds. Conclusions Suturing and knotting in SILS and NOTES are currently challenging techniques, but the proposed device enables the suture to be automatically passed around ducts. It is expected that clinical evaluations of future prototypes will further confirm the efficacy of the device.

Beyond the Square knot: A validation study for a novel knot-tying method named “inverse 9”

“…The results demonstrated that the trainees using the “inverse 9” LSKT method achieved proficiency faster than those using the traditional LSKT method, confirming that the “inverse 9” LSKT method can be mastered more quickly. The traditional LSKT method's laparoscopic winding operation was found to increase the knot-tying time due to its difficulty and uncertainty, as reported previously in the literature [ 15 ]. Additionally, the coiling operation in the traditional LSKT method required a longer thread length and more operating space [ 16 , 17 ], which was not necessary in the “inverse 9” LSKT method.…”