Critical Steps of Suturing Laparoscopically | Prof Farhan Zaheer | DMC | DUHS | Colocon 2022

Critical Steps of Suturing Laparoscopically |
Prof Farhan Zaheer
Professor of Surgery
Dow Medical College
Advance Laparoscopy Skills and GI stapler Workshop
Colocon 2022

Laparoscopic suturing, also known as minimally invasive surgery or keyhole surgery, is a technique used to close incisions or repair internal tissues using small incisions and specialized instruments. Suturing during laparoscopy requires precision and skill. Here are the critical steps for suturing laparoscopically:

1. **Prepare the Patient:** Before starting the procedure, the patient is prepped and positioned in a way that provides optimal access to the surgical site. Pneumoperitoneum, where carbon dioxide gas is used to inflate the abdominal cavity, is established to create a workspace for the laparoscopic instruments.

2. **Port Placement:** Small incisions are made, typically 5-12 mm in size, through which trocars and ports are inserted. These ports serve as entry points for laparoscopic instruments, including the camera and needle holders.

3. **Visualization:** A laparoscope with a camera is inserted through one of the ports to provide a clear view of the surgical site. The surgeon and the surgical team watch the video feed from the laparoscope on a monitor.

4. **Suturing Instruments:** Specialized laparoscopic instruments are used for suturing. These instruments include needle holders, graspers, and suture materials. The surgeon selects the appropriate suture type and size for the specific procedure.

5. **Needle Handling:** Maneuvering the needle in a confined space is a critical skill in laparoscopic suturing. The surgeon uses a needle holder to grasp and manipulate the needle.

6. **Suturing Technique:** There are different suturing techniques used in laparoscopy, including intracorporeal and extracorporeal knot tying. Intracorporeal suturing involves placing knots inside the body, while extracorporeal suturing involves creating knots outside the body and then pulling them into the incision.

7. **Needle Passage:** The surgeon inserts the needle through the tissue that needs to be sutured. This requires precision and careful handling to avoid damaging surrounding structures.

8. **Suture Placement:** After the needle is passed through the tissue, the surgeon secures the suture material and pulls it through. This can be done by hand or using specialized laparoscopic instruments.

9. **Knot Tying:** Depending on the suturing technique, the surgeon either ties knots within the body or externally through one of the ports. Intracorporeal knot tying requires dexterity and is often done using advanced laparoscopic skills. Excess suture material is cut once the knot is secure.

10. **Suturing Continuity:** The surgeon repeats the process of needle passage, suture placement, and knot tying as needed to close incisions or repair tissues completely.

11. **Hemostasis:** Ensuring there is no bleeding from the sutured site is crucial. Any bleeding is carefully addressed, often through cauterization or the application of hemostatic agents.

12. **Closure and Inspection:** Once the suturing is complete, the surgeon inspects the surgical site and surrounding areas for any issues. The laparoscopic instruments and ports are removed, and the incisions are closed with sutures or staples.

13. **Postoperative Care:** The patient is carefully monitored post-surgery for any signs of complications or infection.

Laparoscopic suturing requires extensive training and practice due to the limited space, two-dimensional view, and the intricacies of laparoscopic instruments. It's a critical skill for many minimally invasive surgical procedures and is often performed by experienced surgeons.

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