Suture damage after grasping with EndoWrist of the da Vinci Surgical System

Robotic surgery using the da Vinci Surgical System promises to extend the capabilities of minimally invasive surgery and many surgical specialties are applying this new technology. With the progress of robotic surgery, we have many opportunities to perform intracorporeal anastomosis and knotting. In these procedures, we use needle drivers, and we sometimes experience collapse of sutures after grasping them due to the lack of tactile feedback. In this study, we evaluated the relationship between the decrease of durability and robotic manipulation and whether a difference in endurance can be observed using different types of robotic instruments or needle drivers for conventional laparoscopic surgery. We held 4-0 mono-filament sutures with three types of EndoWrist: Large Needle Driver (LND), Cadiere Forceps (CF) and Debaky Forceps (DF) of the da Vinci surgical system once or three times and measured the decrease of durability of the suture. The mean tensions of the suture were significantly decreased after robotic manipulation with LND. The mean tension after holding three times with LND was significantly less than that with the CF. During intracorporeal anastomosis and knotting in robotic surgery, it is important to decrease the necessity to hold the suture directly with EndoWrist. If needed, the best EndoWrist to use is CF or DF, but not LND.