It stands for efficacy and enjoyment 1

BASIC KNOWLEDGE
SUTURING & KNOTTING
IN LAPAROSCOPIC SURGERY

INDONESIAN SOCIETY OF
ENDO-LAPAROSCOPIC SURGEONS

Dr. Barlian Sutedja, SpB

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 BACKGROUND
Since the early 1980s there have been dramatic
advances in the application of laparoscopic
techniques to conventional abdominal
operations and the mastery of laparoscopic
suturing and knotting becomes an important
endo-laparoscopic skill.

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 PROCEDURES OF LAPAROSCOPIC
SUTURING AND KNOTTING

ENDOLIGATURE PROCEDURE
ENDOLOOP ( ROEDER KNOT )

EXTRACORPOREAL PROCEDURE

INTRACORPOREAL PROCEDURE

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ENDOLIGATURE PROCEDURE

ENDOLOOP ( ROEDER KNOT )

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ROEDER KNOT ( 1 )

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ROEDER KNOT (2)

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ROEDER KNOT (3)

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ROEDER KNOT (4)

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ENDOLIGATURE PROCEDURE
ENDOLOOP ( ROEDER KNOT )

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LAPAROSCOPIC APPENDECTOMY
ENDOLOOP TECHNIQUE

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INTRACORPOREAL PROCEDURE

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INTRACORPOREAL PROCEDURE
LAPAROSCOPIC NEEDLE HOLDER

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Needle Introduction
Equipments

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Art of Endosuturing
Needle Introduction

Needle holder

5 mm reducer

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Art of Endosuturing
Needle Introduction
Hold the suture in the
middle

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Art of Endosuturing
Needle Introduction

Pull the needle inside

the reducer…

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Art of Endosuturing
Needle Introduction

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Art of Endosuturing
Needle Introduction

10 mm port

Needle holder + 5
mm reducer
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Art of Endosuturing
Needle Introduction

Expose the needle (in

the abdomen)

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Art of Endosuturing
Needle Introduction

Ready!

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Art of Endosuturing
 Co-axis theory

Co-axis is usual

Isosceles triangle is better 23

2008/11/28
 Para axis setting

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2008/11/28
 Para-axis
Do you eat asetting
dinner like this?

• Out of axis is unusual= TIRED !!

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2008/11/28
 Eating setting
Co-axis Dinner

Co-axis is usual in our daily life 26

2008/11/28
 Port site for operations
based on the co-axial theory

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2008/11/28
 Trocar position of LRYGBP

Co axial setting

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2008/11/28
 Restriction of movement of
“Move the ground”
Instruments
theory

Kazunori Kasama MD
Yotsuya Medical Cube
MIS center

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2008/11/28
 “Move the Ground” theory

Instruments axis vs. Dissection vector

Dissection in open surgery

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2008/11/28
 “Move the Ground” theory
Instruments axis vs. Dissection vector

Dissection in open surgery

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2008/11/28
 “Move the Ground” theory
Instruments axis vs. Dissection vector

Dissection in open surgery

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2008/11/28
 “Move the Ground” theory
Instruments axis vs. Dissection vector

Dissection in laparoscopic surgery

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2008/11/28
 “Move the Ground” theory
Instruments axis vs. Dissection vector

Dissection in laparoscopic surgery

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2008/11/28
 “Move the Ground” theory
Instruments axis vs. Dissection vector

Dissection in laparoscopic surgery

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2008/11/28
 “Move the Ground” theory
Instruments axis vs. Dissection vector

Dissection in laparoscopic surgery

•Restriction of movement of Instruments

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2008/11/28
 “Move the Ground” theory
Instruments axis vs. Dissection vector

Dissection in laparoscopic surgery

“Move the ground”

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2008/11/28
POSITION OF NEEDLE DRIVER AND THE
ASSISTING GRASPER

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PORT POSITION

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PROPER ALIGMENT

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NEEDLE ADJUSTMENT BY MANEUVERING SUTURE

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NEEDLE ERECTION BY PRESSING OVER IT

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NEEDLE ADJUSTMENT BY TIP

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SQUARE SLIP KNOT

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SQUARE SLIP KNOT

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EXTRACORPOREAL PROCEDURE
ROEDER TECHNIQUE

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EXTRACORPOREAL KNOTTING

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CLINICAL APPLICATIONS OF LAPAROSCOPIC
SUTURING & KNOTTING

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CLINICAL APPLICATIONS OF LAPAROSCOPIC
SUTURING & KNOTTING

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CLINICAL APPLICATIONS OF LAPAROSCOPIC
SUTURING & KNOTTING

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CLINICAL APPLICATIONS OF LAPAROSCOPIC
SUTURING & KNOTTING

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THANK YOU FOR YOU

ATTENTION

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SQUARE SLIP KNOT

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