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Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
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Initial experience using a handheld fully articulating software-driven laparoscopic needle driver in TAPP inguinal
Victoria Needham1,2, Diego Camacho3,4, Flavio Malcher3,4
1Department of Surgery, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA. vgilbert08@gmail.com.
Surgical Endoscopy
|April 7, 2021
Summary
A new articulating needle driver for laparoscopic inguinal hernia repair (TAPP) shows promise. It offers comparable results to standard methods for mesh fixation and suture closure, potentially reducing costs.
Area of Science:
- Minimally Invasive Surgery
- Surgical Technology
- Hernia Repair
Background:
- Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair presents ergonomic challenges.
- A novel handheld, software-driven laparoscopic articulating needle driver was developed to address these difficulties.
Purpose of the Study:
- To evaluate the effectiveness of a new laparoscopic articulating needle driver in TAPP inguinal hernia repair.
- To compare surgical times for mesh fixation and peritoneal closure using the new device versus standard laparoscopy.
- To assess the learning curve and cost-effectiveness of the articulating needle driver.
Main Methods:
- Video analysis of TAPP cases using the articulating device compared to standard laparoscopy.
- Time analysis of mesh fixation and peritoneal suture closure, comparing early vs. later cases.
- Cost analysis of the two techniques.
Main Results:
- Peritoneal closure time per suture pass improved significantly after an initial 10-case learning period (60.61s to 38.84s), becoming comparable to standard laparoscopy (34.8s).
- Mesh fixation time was longer with the articulating device (462.4s) compared to tacker devices (227s), though not statistically significant (p=0.06).
- Suture closure with the articulating device was more cost-effective than tack fixation; left-sided repairs took longer for peritoneal closure than right-sided repairs.
Conclusions:
- A laparoscopic articulating needle driver is comparable to standard laparoscopy for TAPP inguinal hernia repair after a brief initial experience.
- Suture mesh fixation using the articulating device minimizes the need for expensive tacker devices, offering a cost-effective alternative.
- The articulating needle driver is a promising tool for minimally invasive hernia repair.
