The benefits of automated suturing devices in gynecologic endoscopic surgeries: the Endo Stitch and SILS Stitch.

Traditional laparoscopic suturing and knot tying requires a steep learning curve and is often the rate-limiting step in performing advanced laparoscopic gynecologic surgical procedures. It is particularly challenging due to difficulties with tissue handling and needle control while performing the procedure on a two-dimensional screen, oftentimes at unfavorable suturing angles. Automated suturing devices have greatly simplified the process and allow less-experienced surgeons to safely and efficiently perform laparoscopic suturing and knot tying. The Endo Stitch (Covidien, Mansfield, MA) is a 10-mm single-use suturing device that allows placement of multiple suture types during laparoscopic surgery, and simplifies the process of laparoscopic knot tying. The SILS Stitch (Covidien, Mansfield, MA) is based on the same technology as the Endo Stitch with the added advantage of articulation up to 75 degrees and rotation up to 360 degrees. This enables surgeons to operate in tight spaces during advanced laparoscopic procedures, and to reach tissues in their natural anatomical position rather than pulling or manipulating tissue into the suturing device. Newer technologies in laparoscopic surgery, such as the Endo Stitch and SILS Stitch, may allow gynecologic surgeons to expand their surgical repertoire of advanced laparoscopic procedures.