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Tying Sutures in Single-Port Laparoscopy

The use of single-port surgery is rapidly increasing. It was first reported by Navarra et al.,1 who performed a cholecystectomy single-port access in 1997. Several clinical studies have reported on the increased difficulty of single-port surgery compared with standard laparoscopic surgery, based on operative time and surgeon perception.24 Ishiyama et al.5 demonstrated that intracorporeal suturing is more difficult in single-port surgery than in standard laparoscopic surgery. The problem addressed is the technical difficulty arising when all the trocars enter in parallel, which prevents triangulation (Fig. 1). In these circumstances, tying sutures can be very problematic. We recommend as a standard suture technique that knotting in combination with a triple rotation of the needle holder (Fig. 2). The technique consists in forming the intracorporeal knot with the needle holder clasping the central part of the needle and rotating it completely three times. Then, the other holder clasps the needle at the closest point to the tip, and the holder with the triple loop releases the needle and is applied to the other end of the suture, pressing and pulling it, thus completing the knotting. We believe this technique is simple and reproducible, and that both in the single-port approach and in all other situations in which the two entry ports used are in parallel, it provides a useful alternative means of tying sutures. F. J. Pérez Lara, M.D. Service of Surgery Antequera Hospital Málaga, Spain