Endoscopic suturing and knotting

As the minimally invasive approach to surgery has taken a firm foothold the new quest has been to find if there were any limits to procedures being done entirely "closed". The obvious patient and cost benefits had already been established, thus many a creative and adventurous surgeon busily explored these possibilities. It has already been demonstrated clinically that laparoscopic tubotubal reanastomosis is feasible and in the experimental setting laparoscopic vesico-urethral anastomosis (following laparoscopic radical prostatectomy), and fetoscopic repair of a cleft lip, all using fine sutures, are possible. The answer seemed to lie in the limitations: setup, skill, technique, visualization, and instrumentation. Problems with visualization have been addressed during the past decade and substantial gains have been made in optical and audio-visual technology. Instrumentation lagged behind, not only because of astronomical demand but also because of the lack of understanding of the exact needs of the laparoscopic surgeon. A good deal of borrowing or adaptation of conventional instruments has occurred which has been beneficial in the sense that these were familiar to surgeon (habit is stronger than logic). The problem was the that highly restricted operative field rendered many of them nearly useless. New instruments had to be developed and many innovative designs have since become available for almost everything but suturing and knot tying.