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BackgroundRobotic technology is an important tool in surgical innovation, with robots increasingly being used in the clinical setting. Robots can be used to enhance accuracy, perform remote actions, or to automate tasks. One such surgical task is suturing, a repetitive, fundamental component of surgery that can be tedious and time consuming. Suturing is a promising automation target because of its ubiquity, repetitive nature, and defined constraints. This systematic review examines research to date on autonomous suturing.MethodsA systematic review of the literature focused on autonomous suturing was conducted in accordance with PRISMA guidelines.Results6850 articles were identified by searching PubMed, Embase, Compendex, and Inspec. Duplicates and non-English articles were removed. 4389 articles were screened and 4305 were excluded. Of the 84 remaining, 43 articles did not meet criteria, leaving 41 articles for final review. Among these, 34 (81%) were published after 2014. 31 (76%) were published in an engineering journal9 in a robotics journal, and 1 in a medical journal. The great majority of articles (33, 80%) did not have a specific clinical specialty focus, whereas 6 (15%) were focused on applications in MIS/laparoscopic surgery and 2 (5%) on applications in ophthalmology. Several suturing subtasks were identified, including knot tying, suture passing/needle insertion, needle passing, needle and suture grasping, needle tracking/kinesthesia, suture thread detection, suture needle shape production, instrument assignment, and suture accuracy. 14 articles were considered multi-component because they referred to several previously mentioned subtasks.ConclusionIn this systematic review exploring research to date on autonomous suturing, 41 articles demonstrated significant progress in robotic suturing. This summary revealed significant heterogeneity of work, with authors focused on different aspects of suturing and a multitude of engineering problems. The review demonstrates increasing academic and commercial interest in surgical automation, with significant technological advances toward feasibility.

Background Endoscopic sleeve gastroplasty is an example of endoscopic sutured plications being used to remodel a gastrointestinal organ. With per-oral plication of the esophagus (POPE), similar plications are used to remodel the dilated and redundant megaesophagus of end-stage achalasia. Redundancies and dilations can also develop in the neoesophagus of a patient with prior esophagectomy. Megaesophagus and a redundant neoesophagus can both lead to debilitating dysphagia, regurgitation, and recurrent aspiration pneumonia. Traditionally, this anatomic problem requires complex revisional or excisional surgery, to which POPE offers an incisionless alternative. Methods This is a dynamic manuscript with video demonstration of POPE, as well as review of five cases performed in 1 year. Data were collected in a prospectively maintained database, and the institutional review board approved retrospective review for this publication. The procedure is performed using a dual-channel upper endoscope fixed with an endoscopic suturing device, with the patient supine under general anesthesia. Results POPE was technically completed in all cases with no serious complications, and patients either went home the same day or spent one night for observation. Most patients reported immediate and substantial symptomatic improvement. Objective pre- and post-measures include esophagram and nuclear gastric emptying studies. Conclusion This article discusses early experience at one institution with POPE, with detailed description of the procedure and technical considerations. An accompanying video reviews two cases, one with megaesophagus and one with a gastric conduit. While this novel procedure has limited and rare indications, it offers a low-morbidity solution to a challenging anatomic problem that traditionally requires invasive surgery.

BackgroundMoorthy checklist (MC) and laparoscopic skill competency assessment tool (LS-CAT) are tools commonly used to evaluate the quality of laparoscopic suturing. The current assessment model is single measurement by multiple raters. Our aim is to examine the reliability of the current assessment model and tools.MethodsWith IRB approval, participants of three different backgrounds, namely medical students, trainees, and surgeons, were enrolled. The participants each accomplished a standardized laparoscopic suturing task. The performances were video-recorded and reviewed with LS-CAT and MC independently by three blinded raters. Intraclass correlation coefficients (ICC) were calculated for inter-rater and intra-rater reliability.Results26 participants were enrolled, comprising 10 students, 10 trainees and 6 surgeons. In regard of inter-rater reliability, ICC values (95% CI) were 0.909 (0.768–0.961) and 0.868 (0.608–0.948) in LS-CAP and MC, respectively. For students, ICC values were 0.908 (0.682–0.976) and 0.815 (0.408–0.951) in LS-CAT and MC, respectively. For trainees, ICC values were 0.812 (0.426–0.947) and 0.717 (0.102–0.925), respectively. For surgeons, ICC values were 0.720 (0.064–0.955) and 0.868 (0.608–0.948), respectively. In regard of intra-rater reliability, ICC values of the mean scores from the three raters were 0.956 (0.905–0.980) and 0.925 (0.842–0.966) in LS-CAP and MC, respectively.ConclusionLS-CAT and MC are both qualified assessment tools for laparoscopic suturing. LS-CAT is more reliable particularly for medical students and trainees. The current assessment model of single measurement by multiple raters provides excellent reliability.

Background/Objectives: Facial nerve injury from conditions such as Bell’s palsy, trauma, surgery, and infection leads to facial asymmetry and motor deficits. Axotomy models reproduce peripheral nerve disruption and consequent motor impairment. To compare the effects of forward versus reverse autologous nerve suturing on neural regeneration and motor recovery within the facial nucleus after axotomy. Methods: In rats subjected to facial nerve axotomy, motor recovery was assessed at 8 weeks using whisker movement and blink reflex tests. Immunohistochemistry quantified choline acetyltransferase (ChAT), sirtuin 1 (SIRT1), and Iba-1 as indices of cholinergic function, cellular stress/inflammation modulation, and microglial activation in the facial nucleus. Results: Axotomy significantly reduced whisker and blink scores compared with sham. Both forward and reverse suturing significantly improved these behavioral outcomes versus axotomy. Within the facial nucleus, axotomy decreased ChAT- and SIRT1-positive cells and increased Iba-1 expression, while both suturing techniques increased ChAT and SIRT1 and reduced Iba-1. These changes suggest enhanced cholinergic function, mitigation of stress/inflammatory responses, and attenuation of microglial activation following repair. Conclusions: Forward and reverse suturing were each associated with improved motor function and favorable molecular and cellular changes in the facial nucleus after facial nerve axotomy. These findings support the utility of surgical repair irrespective of graft orientation and highlight involvement of key pathways—cholinergic signaling, SIRT1-related regulation, and microglial activity—in nerve restoration. This work extends our previous study, which focused on peripheral nerve regeneration after forward and reverse suturing, by elucidating how graft orientation affects central facial nucleus responses. By integrating behavioral outcomes with ChAT, Iba-1, and SIRT1 expression, the present study provides novel insight into the central mechanisms underlying motor recovery after facial nerve repair and helps explain why comparable functional outcomes are achieved regardless of graft polarity.

Background Primary suturing of the common bile duct (CBD) is increasingly used in laparoscopic common bile duct exploration (LCBDE) for selected patients, though the optimal suturing method remains unclear. This study compares the efficacy of continuous versus interrupted sutures for primary CBD closure in patients with CBD stones. Methods A retrospective analysis was conducted on 120 patients with CBD stones who underwent primary CBD closure at Yancheng First People’s Hospital from October 2022 to December 2023. Data included demographics, hospital stay, complications, and follow-up outcomes. Of these, 69 received continuous sutures, and 51 received interrupted sutures. Results No significant differences were found in age, gender, body mass index (BMI), CBD diameter, preoperative bilirubin levels, or stone residuals between groups. The incidence of postoperative fever, bile leakage, electrolyte disturbances, bleeding, wound infection, and CBD stricture was similar. Continuous suturing required less operative time than interrupted suturing ( p  < 0.01). Conclusion Both continuous and interrupted suturing techniques are safe and effective for CBD closure in selected patients, though continuous suturing is more time-efficient.

Objective This study aims to explore an efficient teaching method to improve laparoscopic suturing skills in resident physicians by combining the progressive training method with the imagery training method. Methods This study used a randomized controlled trial methodology. The experimental group received training utilizing a combination of the progressive training method and the imagery training method In contrast, the control group followed the traditional teaching method of practicing continuous complete actions. Both groups were trained in intracorporeal suturing and knot-tying under laparoscopy. The training effects of the two groups were compared and analyzed before and after the training, including LS-CAT scores and suturing time. Results In the second test, the experimental group had much higher LS-CAT scores than the control group, as well as a considerably lower number of operation errors. In the experimental group, 88.9% of the trainees were proficient, compared to only 28.6% in the control group. There was no significant difference in suturing time between the two groups. The results of the third test indicated that, although there were no significant differences in LS-CAT total scores or suturing time between the two groups, the experimental group demonstrated a significantly lower number of operational errors compared to the control group. Additionally, the LS-CAT scores for tissue handling in the experimental group were significantly better than those in the control group. Conclusion The combination of the progressive training method and the imagery training method significantly improved resident physicians’ laparoscopic suturing skills. This method greatly enhanced the efficiency and quality of learning laparoscopic suturing and knot-tying skills among surgical and gynecological resident doctors.

BackgroundReported recurrence rates using jumping purse-string suturing in laparoscopic hernia repair (LH) are higher than that of intact purse-string. This study aims to compare the outcomes of LH using transabdominal jumping purse-string suturing (TJS) with those using transabdominal intact purse-string suturing (TIS) and percutaneous extraperitoneal intact purse-string suturing (PEIS).MethodsA total of 3340 patients from three centers who have undergone laparoscopic hernia repair from January 2016 to June 2019 were retrospectively reviewed. Of these, 1460 patients received TJS, 724 patients received TIS, and 1006 patients received PEIS. One hundred and fifty patients were excluded due to the loss of follow-up. Demographic characteristics, intraoperative findings, and postoperative complications were analyzed.ResultsThe hernia distribution characteristics and mean length of hospital stay were similar among the three groups (p > 0.05, p > 0.05). While the overall complication rates were similar among the three groups (0.34% in TJS vs. 0.41% in TIS vs. 0.50% in PEIS, TJS & TIS p = 0.502; TJS & PEIS p = 0.813), the incidence of intraoperative hematoma in TIS group and postoperative subcutaneous knot in PEIS group was significantly higher ((0.83% in TIS and 0.34% in TJS vs. 0.2% in PEIS, TJS & TIS p = 0.018; TJS & PEIS p = 0.163), (0% in TIS and 0% in TJS vs. 0.2% in PEIS, TJS & TIS p = 0.415; TJS & PEIS p = 0.025)). There were no differences in the recurrent rate in both unilateral and bilateral cases.ConclusionsTransabdominal jumping purse-string suturing is not associated with a higher recurrence rate and is the recommended surgical approach.

ObjectiveEndoscopic sleeve gastroplasty (ESG), an incisionless endoscopic bariatric procedure, has shown impressive results in case series. This study examines the reproducibility, efficacy, and safety in three centers across two countries, and identifies key determinants for procedural success.DesignPatients who underwent ESG between February 2016 and May 2017 at one of three centers (Australia and USA) were retrospectively analyzed. All procedures were performed on an outpatient basis using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Primary outcomes included absolute weight loss (ΔWeight, kg), change in body mass index (∆BMI, in kg/m2), total body weight loss (TBWL, %), excess weight loss (EWL, in %), and immediate and delayed adverse events.ResultsIn total, 112 consecutive patients (male 31%, age 45.1 ± 11.7 years, baseline BMI 37.9 ± 6.7 kg/m2) underwent ESG. At 1, 3, and 6 months, Δweight was 9.0 ± 4.6 kg (TBWL 8.4 ± 4.1%), 12.9 ± 6.4 kg (TBWL 11.9 ± 4.5%), and 16.4 ± 10.7 kg (TBWL 14.9 ± 6.1%), respectively. The proportion of patients who attained greater than 10% TBWL and 25% EWL was 62.2 and 78.0% at 3 months post-ESG and 81.0 and 86.5% at 6 months post-ESG. Weight loss was similar between the three centers. Multivariable analysis showed that male sex, greater baseline body weight, and lack of prior endoscopic bariatric therapy were predictors of greater Δweight at 6 months. Three (2.7%) severe adverse events were observed.ConclusionsESG is an effective, reproducible, and safe weight loss therapy that is suitable for widespread clinical adoption.

Background and aim Traditionally, practical skills are taught on face-to-face (F-F) basis. COVID-19 pandemic brought distance learning (DL) to the spotlight because of the social distancing mandates. We sought to determine the acceptability and effectiveness of DL of basic suturing in novice learners. Methods A prospective randomized controlled trial involving 118 students was conducted. Participants were randomized into two groups for learning simple interrupted suturing: F-F and DL-groups. Evaluation was conducted by two assessors using a performance checklist and a global rating tool. Agreement between the assessors was calculated, and performance scores of the participants were compared. Participants’ satisfaction was assessed via a questionnaire. Results Fifty-nine students were randomized to the F-F group and 59 to the DL-group. Satisfactory agreement between the assessors was demonstrated. All participants were successful in placing three interrupted sutures, with no significant difference in the performance between the groups. 25(44.6%) of the respondents in the DL-group provided negative comments related to the difficulties of remotely learning visuospatial concepts, 16(28.5%) preferred the F-F approach. Conclusion DL of basic suturing is as effective as the F-F approach in novice learners. It is acceptable by the students despite the challenges related to the remote learning of practical skills.