Asao T, Yamaguchi S, Tsutsumi S, Mochiki E, Kuwano H
Department of General Surgical Science, Gunma University, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan.
Surg Endosc. 2007 Sep;21(9):1553-6. doi: 10.1007/s00464-006-9173-9. Epub 2007 Feb 16.
Intracorporeal suturing and knot tying are among the most difficult procedures in laparoscopic operations. An easy and inexpensive method for intracorporeal instrumental ligation with a modified laparoscopic needle driver is presented.
The needle driver developed in this study has a novel mechanism that can fix the suturing thread in a hook at the distal site of the holder's jaw hinge. This hook projects out from the rod only when the jaw of the holder is open. After the needle is removed from the tissue using the grasper, the needle driver is placed under the grasper, which the surgeon manipulates by the left hand. Then the thread is hooked on the needle driver by withdrawal of the driver with the jaw opening. The tip of the needle driver is moved over the shaft of the grasper by keeping the thread on the hook. The thread is entwined during a series of crossing movements of the rods of the forceps. The short tail of the suture material is gripped and tied up as a first throw of ligation. The side edge of the jaw, used for thread cutting, is sharpened by grinding.
When the angle of the forceps is set at 90 degrees in the box trainer, no difference in terms of ligation time and degree of error is observed between the hook and conventional C-loop methods. In the case of the 30 degree forceps angle, the novel method is superior to the conventional method.
The novel needle driver provides an easy and inexpensive method for performing an intracorporeal ligation, particularly in a case involving a sharp axis angle of the forceps. More clinical experience is necessary for evaluation of this method, but it has potential advantages in laparoscopic operations.
体内缝合和打结是腹腔镜手术中最困难的操作之一。本文介绍一种使用改良腹腔镜持针器进行体内器械结扎的简便且低成本的方法。
本研究开发的持针器具有一种新颖的机制，可将缝合线固定在持针器钳口铰链远端部位的一个钩子上。仅当持针器钳口打开时，这个钩子才会从杆上伸出。使用抓钳将针从组织中取出后，将持针器置于抓钳下方，由外科医生用左手操作抓钳。然后通过张开钳口撤回持针器，将线钩在持针器上。通过保持线在钩子上，将持针器尖端在抓钳杆上移动。在镊子杆的一系列交叉移动过程中，线被缠绕。抓住缝合材料的短尾并作为第一道结扎线系紧。用于剪线的钳口侧边通过研磨进行了锐化处理。
在箱式训练器中将镊子角度设置为90度时，在结扎时间和误差程度方面，钩子方法与传统C形环方法之间未观察到差异。在镊子角度为30度的情况下，新方法优于传统方法。
这种新型持针器提供了一种简便且低成本的体内结扎方法，特别是在镊子轴角度尖锐的情况下。评估该方法需要更多的临床经验，但它在腹腔镜手术中具有潜在优势。
