It is among the most basic, yet critically important, skills that a surgeon or OR nurse can have. When all is said and done, the integrity of the sutures in internal tissue, the fascia and those closing the surgical site can mean the difference between a successful surgery with full patient recovery or one marked by countless and potentially life threatening complications.

Every surgeon knows how to sew. It is a skill that must be honed and mastered early as it will be employed in virtually every procedure they are called upon to perform. And, in truth, it usually isn’t all that difficult. However, the shifts in surgery toward more minimally invasive approaches, as well as the growing concern with needlestick injury and its potential for spreading infection, have added a bit more difficulty and danger to this once benign activity.

While the benefits of minimally invasive surgery cannot be argued, the difficulty it can cause to standard suturing techniques is significant. The typical needle and thread technique is taken out of the surgeon’s hands and placed at the end of long thin instruments. This can completely nullify the muscle memory that an experienced surgeon has relied on for years.

Fortunately, a number of medical device manufacturing companies are now offering suturing systems and devices aimed at delivering the tactile control and precision associated with open procedures to minimally invasive surgery. As an added bonus, in the process of improving laparoscopic suturing, many manufacturers are also introducing safer technologies designed to protect the surgeon, OR staff and the patient from the risks of needlestick injuries and infection.

The 360° Fascia Closure Device from SuturTek, Inc.
is designed specifically for closing the fascia during
open surgery.
One such company, SuturTek, Inc. (North Chelmsford, MA), offers an innovative device called the 360° Fascia Closure Device that is designed specifically for closing fascia during open surgery. This FDA-approved suturing device helps prevent inadvertent needlesticks to surgeons, nurses, OR staff and patients. It is faster and easier than hand suturing and requires only minimal training and no change in technique by the surgeon or other OR personnel.

The 360° Fascia Closure Device uses a standard fascia closure needle and all standard types of suture materials, but prevents needlesticks to the surgeon and OR staff by shielding the sharp tip of the suture needle during loading, passing, suturing, unloading and disposal. Studies show that facilities purchasing this device and mandating its use to close fascia can prevent upwards of 59 percent of all needlesticks in the operating room, with the added bonus that fascia closure will be faster and easier for the surgeon without any change in closure technique or type of suture materials used.

The Quik-Stitch Suturing System from PARÉ Surgical is currently used in 24 different laparoscopic procedures.
The Quik-Stitch Endoscopic Suturing System from PARÉ Surgical, Inc. (Centennial, CO) can also be used for open procedure, but it is designed to be most beneficial in minimally invasive surgery. This device is a complete 5-mm suture system which includes applicator, needle driver and suture configured with a pre-tied knot. There is no need to worry about knots coming undone or slipping, resulting in leaks after the procedure is completed. The system can also speed up the time it takes a surgeon to tie knots, resulting in less OR time for each procedure. Both absorbable and non-absorbable sutures are offered in sizes 0/0, 2/0 and 3/0.

The Quik-Stitch Suturing System is designed such that the surgeon keeps the needle completely in his control and allows him/her to suture in the same manner as is commonly employed in open suturing. Thus, the learning curve is short, with most surgeons learning to effectively and efficiently use the system in the first three to five knots tied.

The CHIA PERCPASSER from DePuy Mitek, Inc. provides optimal access to target anatomy and is small enough to fit through an 18g spinal needle.
The Quik-Stitch was developed as a reusable system that can be easily disassembled and autoclave sterilized or as a disposable to be discarded after each procedure. The system is currently being used in 24 different laparoscopic procedures by General, Gynecology and Urology surgeons.

DePuy Mitek, Inc. (Norwood, MA), a Johnson & Johnson company and a leading manufacturer of surgical sports medicine devices, recently introduced the CHIA PERCPASSER™, a percutaneous suture shuttling device. In addition to access to target anatomy that a percutaneous approach provides, this suture shuttling device is small enough to pass through an 18g spinal needle allowing precise placement of sutures without cannula restrictions in the limited working area of the subacromial space and glenohumeral joint.

The CHIA PERCPASSER is a 19-inch long device made out of braided nitinol wire with a kite (loop) on one end. It is introduced percutaneously, kite end first, through a spinal needle in the desired location. The needle is then removed and the kite end of the device is retrieved with a grasper through the appropriate cannula. The suture is placed through the kite end of the CHIA PERCPASSER and withdrawn percutaneously, then removed from the device and stored percutaneously.

Aesculap’s “Suturing Made Simple” laparoscopic axial needle holders offer superior needle control and secure grasping for suturing of both fine and coarse tissues.
The percutaneous organization provides both external and internal visual confirmation of sutures being managed arthroscopically. This methodical, minimally invasive suture management offered by the CHIA PERCPASSER can address a variety of surgical repairs including rotator cuff, shoulder instability and meniscal repairs.

To address the needs specific to laparoscopic surgeons, Aesculap, Inc. (Center Valley, PA) has developed a full suite of instruments that provide the control, precision and tactile feel of open suturing to laparoscopic suturing, no matter what techniques are used. Their “Suturing Made Simple” laparoscopic axial needle holders offer superior needle control and secure suture grasping for suturing of both fine and coarse tissues. The unique ergonomic handle fits comfortably in the palm and allows the instruments to be turned with extreme ease at the wrist. The shape and geometry of the jaw makes it easy to grasp tissues in any position, supporting the two needle holder approach and facilitating suturing in a coordinated and efficient manner. Designed as a quick locking, one-step system with a reinforced design, the needle holder is easy to use and offers an impressive working life. A variety of patterns are available for the “Suturing Made Simple” needle holders with multiple jaw designs and 31-cm or 37-cm lengths.

The Deep Suture device from Automated Medical Products is designed for the safe and easy closing of the fascia
during minimally invasive surgery.
The Deep Suture device from Automated Medical Products Corp. (Edison, NJ) is designed for the safe and easy closing of the fascia during minimally invasive surgery. The reusable device is placed under video observation while maintaining pneumoperitoneum. In two easy movements the needles and sutures are placed and driven through the fascia while under continuous observation by the surgeon. As all of the manipulations are performed under full video observation, the surgeon and staff are provided with the confidence that wound will be closed without catching extraneous material.

Economical and solidly engineered, the Deep Suture fits comfortably in the surgeon’s hand. The proprietary design of the swedged-on needles and sutures minimizes the potential of any needles getting lost in the abdominal cavity and maximizes the safe and efficient closing of the fascia. The Deep Suture device has a flush port to accommodate easy and thorough cleaning. Plus, a variety of suture materials and needle lengths are available exclusively for the device.

With a 14-gauge outside diameter, the Puncture Closure Device from Ranfac Corporation accommodates any size suture and any size trocar.
Ranfac Corporation’s (Avon, MA) Puncture Closure Device provides optimal efficiency with its one hand operation. It enables the surgeon to rapidly close multiple trocar sites securely and safely with a single device. In addition to trocar site closure, the device can in useful in a variety of other procedures. It can be used to tack up hernia mesh prior to final placement, to ligate abdominal wall bleeding and for percutaneous suturing. With a 14-gauge outside diameter, the Puncture Closure Device accommodates any size suture and any size trocar.

First marketed in 1994, the ENDO STITCH™ 10-mm single use automatic suturing device from AutoSuture, a Division of US Surgical (Norwalk, CT), has numerous applications in endoscopic procedures. The suturing system affords surgeons the ability to perform extracorporeal and/or intracorporeal knot tying, including running and interrupted sutures. Sutured needles are available in a variety of suture material, sizes and lengths of seven or 48 inches delivered by the ENDO STITCH Single Use Loading Unit or the ENDO STITCH Triple-Stitch Single Use Loading Unit.

As can be seen, there is no shortage of new technology designed to address the ever advancing requirements of both open and laparoscopic suturing. These suturing systems and devices represent the latest developments the market has to offer to help surgeons more effectively, and more safely, practice their trade.