Optimal angle between instrument shaft and handle for laparoscopic bowel suturing

Abstract

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.