Basic Laparoscopic Surgical Techniques

  • Jeffrey W. Milsom
  • Bartholomäus Böhm


The ability to suture in laparoscopic colorectal surgery is necessary less frequently than in conventional surgery, yet this ability is essential in certain critical situations, such as securing vascular pedicles, ensuring hemostasis, providing tissue support, maintaining tissue closure, and in creating certain surgical anastomoses. Although the principles of suturing and tying knots in endoscopic surgery are identical to those in conventional surgery, major modifications in technique are necessary as a result of the following:
  • The lack of direct manual contact, for which palpation with current laparoscopic instruments cannot completely compensate.

  • The limited movement of current instruments that are inserted through a cannula anchored to the abdominal wall. The working field is a cone with a fixed point at the insertion point of the cannula. Because of the limited field of movement of laparoscopic instruments, proper placement of the cannula is critical.

  • The lack of normal binocular vision without true depth perception, which makes conventional techniques difficult to apply.


Suture Material Conventional Surgery Laparoscopic Colorectal Surgery Monofilament Suture Needle Holder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    McComb PF. A new suturing instrument that allows 8. the use of microsuture at laparoscopy. Fertil Steril. 1992; 57: 936–938.PubMedGoogle Scholar
  2. 2.
    Reich H, Clarke HC, Sekel L. A simple method for ligating with straight and curved needles in operative laparoscopy. Obstet Gynecol. 1992; 79: 143–147.PubMedGoogle Scholar
  3. 3.
    Gazayerli MM. The Gazayerli knot-tying instrument or ligator for use of diverse laparoscopic surgical procedures. Surg Laparosc Endosc. 1991; 1: 254–258.PubMedGoogle Scholar
  4. 4.
    Kennedy JS. A technique for extracorporeal suturing. J Laparoendosc Surg. 1992; 2: 269–272.PubMedCrossRefGoogle Scholar
  5. 5.
    Pietrafitta JJ. A technique of laparoscopic knot tying. J Laparoendosc Surg. 1992; 2: 273–275.PubMedCrossRefGoogle Scholar
  6. 6.
    Semm K. Tissue-puncher and loop-ligation-new aids for surgical-therapeutic pelviscopy (laparoscopy) = endoscopic intraabdominal surgery. Endoscopy. 1978; 10: 119–124.PubMedCrossRefGoogle Scholar
  7. 7.
    Nathanson LK, Nathanson PDK, Cuschieri A. Safety of vessel ligation in laparoscopic surgery. Endoscopy. 1991; 23: 206–209.PubMedCrossRefGoogle Scholar
  8. 8.
    Cuschieri A, Buess G, Perissat J. Operative Manual of Endoscopic Surgery. New York, N.Y.: Springer-Verlag, 1993.Google Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Jeffrey W. Milsom
    • 1
  • Bartholomäus Böhm
    • 2
  1. 1.Section of Colorectal Surgery Research, Department of Colorectal SurgeryThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Universitätsklinik und Poliklinik für ChirurgieUniversitätsklinikums CharitéBerlinGermany

Personalised recommendations