A Comparison of Tissue Handling Forces Between a Novel Suturing Device for Standardised Abdominal Wall Closure and Manual Needle-Driver Suturing

Abstract

Introduction: Suturing is a fundamental component of surgical procedures, wherein training emphasises the significance of gentle tissue handling. The suturing process involves the pressure exerted by the forceps onto the tissue, as well as the medial traction force applied to stabilise the tissue during the needle bite. This study examined the forces involved in tissue handling during suturing, comparing a novel suturing device for standardised abdominal closure with two sizes of curved suture needles (NDS). Methods: A model was developed to measure suturing forces. The study introduction comprised both a written letter and an oral explanation. Participants performed 10x3 needle pull-throughs, using a large needle (36 mm, LN) and a small needle (26 mm, SN). Maximum forceps pressure and maximum medial traction forces were recorded. Additionally, needle pull-through time and the area under the curve (AUC) were calculated for both forceps pressure and medial traction pressure. Results: The study involved 20 specialists, ten scrub nurses, and five surgical trainees. Of these participants, 22 were female, the average glove size was 6.9, and two were left-handed. The use of SutureTOOL resulted in significantly less force exerted with forceps (p<0.001) when compared to NDS, and a shorter needle pull-through time (p<0.001). No differences were observed in maximum traction force; however, the medial traction force AUC was lower for SutureTOOL and SN compared to LN (p=0.025). Conclusion: The study revealed that SutureTOOL required less forceps pressure and exerted either less or comparable traction force to perform needle pull-throughs, compared to traditional methods. We conclude that this innovative suturing technology did not increase the forces measured in the model. However, the impact on abdominal wall related complications requires further study.