Optimal angle between instrument shaft and handle for laparoscopic bowel suturing

Objective. To determine the optimal angle between the handle and instrument shaft for endoscopic suturing. Design A rocker handle needle driver was used to investigate the 0\ub0, 40\ub0, and 80\ub0 handle-to-shaft angles. The standard task entailed closure of a 50-mm enterotomy in a nonliving porcine small-bowel model. Fifty enterotomies were performed with each angle in a random sequence. Setting Research laboratory in the Surgical Skills Unit at Ninewells Hospital. Participants Ten surgeons with previous experience in laparoscopic surgery. Main Outcome Measures The execution time (in minutes), leakage pressure (in centimeters of water), and suture error placement score (deviations of the entry and exit points <3 mm or >5 mm from the enterotomy edge or between sutures). Results: The 40\ub0 handle-to-shaft angle had a higher mean (SD) leakage pressure of 43.8 (20.0) cm H2O compared with the 80\ub0 and 0\ub0 angles (31.1 [21.0] and 26.3 [19.0] cm H2O, respectively) (P<.001). In addition, the 40\ub0 angle had a lower mean (SD) suture error placement score of 13.6 (7.6), compared with the 80\ub0 and 0\ub0 angles (19.4 [9.4] and 21.1 [8.5], respectively) (P<.001). No significant difference was found in the execution time between the different angles (P =3D .20). Conclusion :The best quality of laparoscopic bowel suturing, in terms of the accuracy of suture placement and the integrity of the suture line closure, was obtained with a 40\ub0 handle-to-shaft angle