Practice makes perfect

But better than this only perfect practice makes perfect

And suturing is much more than tying a knot
So we are going through ergonomy and instruments

It important to have a correct patient positioning, a correct team and set up

positioning.
The table should be place at its lowest and usea footrest or a platyform if you
need.
Place your trocars correctly.
And maintain a constant relationship between your eye, instrument and tissue,
and all the information you need in your screen.
So while we are suturing it is very important that your arms are along your body.
It is important that the angle between your arm and your forearm is between 90
degrees and 110 degrees, so you will be more relax while you are suturing. If
you are reducing this angle less than 90 degrees, the tendency will be for you to
open your elbows and use your accesory muscle, and this will get you tired very
quickly. So it is important to maintain this angle and it is important if you are
short or if your patient is very fat, you can use a footrest or platyform to be taller.
So this is our usual trocar set up, we place the primary trocar at the umbilicus,
then three accesory trocars of 5 mm in the left and right anterior superior illiac
spine and one in the middle line or only at the same line as lateral trocar or a
little bit higher, but always at the distance 5 cm from our umbilical port.
So about choosing side to do the suturing, there are the one that usethe two
lateral trocars, so here are the b and the c to do the suturing. So like this you will
have a very good angles to approach to do your suture, the angle will be the
best. But imagine your patient is very fat, you will be like this all the time, so you
will get tired very fast, so poor ergonomy.
You can also use the lateral set up placement. In your right or in your left, this is
very ergonomic, because you are very relax because with your arms in your
body.
But if you want to work in the contralateral side of your trocar placement, it will
be not that easy, it is not that ergonomy for the contralateral side.
So that is why we usually use for suturing this trocar, the suprapubic, and the
left lateral trocar.
And we find that like this we have balance approach to every side of pelvis and
while we have a nice angle to suture.

So this is about choosing side, and let us move to the instruments.

About the trocar, what is important in the suturing, is the valve of the trocar. so
we should not use the metalic valve. We should use the silicon star ship valve,
because it will avoid to lose the gas while we are doing the suturing, while we are
introducing and removing the instruments in the abdominal cavitiy. So use the
silicon star ship valve and also it is important the size or the diameter of the
trocar. If you use a 10 mm trocar, you will have much more tremor and less
precision than when you use a 5 mm trocar. And the same when we use the 3
mm or 5 mm, you will have more precision and less tremor, the smaller the
diameter of the trocar.
And the needle holder, so we have a lot of different needle holder, but the
special we have, the straight needle holder, and the one that we usually use,
because we find it more ergonomy since in laparoscopy with our angle. In
laparatomy we can do rotational movement. And we can approach to the
suturing line for every angle. But in laparoscopy we are by our entries by our
trocar.
By our trocars. So to overcome this problem we use a rotational movement with
our wrist. And for these the straight handle is better than when we use a curve
handle. It is less ergonomy and it is not that good to do a complete rotational
movement. So here is to show you the anatomy
Of the needle holder. You have a fix hanlde that is suppose to be at the fix tip,
And the mobile agle that is suppose mobile
So it is important that your fix handle is to the fix top of your hand. And the
mobile handle to the move of your hands. So the fingers. So it is important when
you grab the needle holderyou dontgrab itlike this with your full hands, use your
fingers.
About the needle anatomy it is importantto knw the needle has t wide
Accross the tissue and the

And also it is important