Optimal angle between instrument shaft and handle for laparoscopic bowel suturing.

OBJECTIVE

To determine the optimal angle between the handle and instrument shaft for endoscopic suturing.

DESIGN

A rocker handle needle driver was used to investigate the 0 degrees, 40 degrees, and 80 degrees handle-to-shaft angles. The standard task entailed closure of a 50-mm enterotomy in a nonliving porcine small-bowel model. Fifty enterotomies were performed with each angle in a random sequence.

SETTING

Research laboratory in the Surgical Skills Unit at Ninewells Hospital.

PARTICIPANTS

Ten surgeons with previous experience in laparoscopic surgery.

MAIN OUTCOME MEASURES

The execution time (in minutes), leakage pressure (in centimeters of water), and suture error placement score (deviations of the entry and exit points <3 mm or >5 mm from the enterotomy edge or between sutures).

RESULTS

The 40 degrees handle-to-shaft angle had a higher mean (SD) leakage pressure of 43.8 (20.0) cm H2O compared with the 80 degrees and 0 degrees angles (31.1 [21.0] and 26.3 [19.0] cm H2O, respectively) (P<.001). In addition, the 40 degrees angle had a lower mean (SD) suture error placement score of 13.6 (7.6), compared with the 80 degrees and 0 degrees angles (19.4 [9.4] and 21.1 [8.5], respectively) (P<.001). No significant difference was found in the execution time between the different angles (P =.20).

CONCLUSION

The best quality of laparoscopic bowel suturing, in terms of the accuracy of suture placement and the integrity of the suture line closure, was obtained with a 40 degrees handle-to-shaft angle.