Suturing intraabdominal organs: when do we cause tissue damage?

• Published in: Surgical endoscopy Vol. 26; no. 4; pp. 1005 - 1009
• Main Authors: Rodrigues, Sharon P., Horeman, Tim, Dankelman, Jenny, van den Dobbelsteen, John J., Jansen, Frank-Willem
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.04.2012; Springer; Springer Nature B.V
• Subjects: Abdomen - surgery; Abdominal Surgery; Animals; Biological and medical sciences; Coronary vessels; Equipment Design; Fallopian tubes; Feedback; Gastroenterology; General aspects; Gynecology; Hepatology; Laparoscopy; Large intestine; Load; Medical sciences; Medicine; Medicine & Public Health; Proctology; Rupture - physiopathology; Stress, Mechanical; Surgery; Sus scrofa; Suture Techniques - adverse effects; Suture Techniques - education; Suture Techniques - standards; Sutures; Tensile Strength; Training; Uterus; Tissue properties; Suturing; Tissue damage; Force feedback; Surgery; Forces; Force measurements; Medicine; Endoscopic surgery; Force measurement; Treatment
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-011-1986-5

Background It is generally assumed that safety of tissue manipulations during (laparoscopic) surgery is related to the magnitude of force that is exerted on the tissue. To provide trainees with performance feedback about tissue-handling skills, it is essential to define objective criteria for judging the safety of applied forces. To be of clinical relevance, these criteria should relate the applied forces to the risk of tissue damage. This experimental study was conducted to determine which tractive forces during suturing cause tissue damage in different types of porcine tissues. Methods Tractive forces were applied on eight different tissue types (fascia, aorta, vena cava, peritoneum, small and large bowel, uterus, and fallopian tube) of 10 different pigs by placing increasingly higher loads on sutures in the tissue. We determined the load at what tissue damage occurred through visual inspection of the tissue. For each tissue sample, three consecutive measurements were performed. Results The average maximum acceptable force varied between 11.43 N for fascia to 1.25 N for fallopian tube. The difference in allowable force between these two structures is almost tenfold. Small bowel can be handled with a tractive force almost 1.5-fold higher than large bowel. Conclusions Each tissue type was found to have its own individual range of acceptable maximum forces before visual tissue damage occurs. With the results presented in this study, it is possible to provide clinically relevant and validated feedback to trainees about their tissue-handling skills.