PARE SURGICAL'S QUIK-STITCH^® ENDOSCOPIC SUTURING SYSTEM

The Quik-Stitch^® Endoscopic Suturing System, by PARE Surgical, Inc. (Englewood, CO), offers secure suturing with a 5-mm delivery system and pre-tied Roeder knot. Quik-Stitch^® makes endoscopic suturing faster, easier, and more secure. For surgeons who have been limited in the procedures they perform endoscopically, this new pre-tied knotting system offers a solution to the problem of the difficulty in tying knots during laparoscopic surgery.

Because surgeons have adapted more and more surgical procedures to minimally invasive approaches, technical solutions have been found for working inside the patient with indirect visibility and limited working space. This change to less invasive surgery has improved patient care dramatically, and has reduced the cost of treatment for many conditions previously treated only by open laparotomy. Hospital length-of-stay is reduced, and many procedures are now performed on an outpatient basis. There is less post-op pain, and quicker return to normal activities. Patients have accepted these changes eagerly, because they want the easiest and shortest possible course of treatment and recovery.

With these changes, surgeons now utilize new technical instruments and work by observing the operative field on a monitor instead of directly. As more procedures are performed laparoscopically, the surgical techniques employed demand innovative approaches. Some of the procedures are changed materially because endoscopic suturing is difficult at best, and in some situations, so difficult that alternative solutions have had to be developed. Clips have been devised for specific uses; but although clips have been used widely in gall bladder surgery, appendectomies, and other procedures, the difficulty in suturing endoscopically remains a limitation in performing many procedures. Surgeons who lack endoscopic suturing skills have fewer options in what procedures they can do endoscopically.

Some continue to perform open procedures in cases in which laparoscopic approaches could be used if the restraints of endoscopic suturing could be mastered.

Edward Felix, M.D., F.A.C.S, Advanced Laparoscopic General Surgeon, Assistant Clinical Professor of Surgery, University of California San Francisco (Fresno, CA), says of the Quik-Stitch^®, "Development of an automatic suturing system has taken a long time, but the new Quik-Stitch^® by PARE Surgical, Inc. is a good product. It allows a surgeon to place the stitch easily, and to knot the stitch with a pre-tied Roeder knot by pushing the knot into place, and then pulling the suture ends.

The knot can be pulled laterally as well as vertically, avoiding tissue damage. The suture can be passed around a structure as well as placed through the tissues. This pass-around feature allows a surgeon to put the suture material around a structure, such as the appendix or the gall bladder, place the knot, and then dissect.

"The learning curve with the Quik-Stitch^® is short when com- pared with the learning curve for suturing endoscopically using more traditional techniques. The Quik-Stitch^® surpasses earlier suture assisting devices, since it is the first that closely approximates manual suturing in its action and security. The initial purchase of the equipment is costly, but in use, the reduced O.R. time balances the high initial costs. More important, surgeons who have difficulty suturing endoscopically can use the Quik-Stitch^® to suture more easily, with a solid, well placed knot delivered where they want it. This pre-knotted suturing product solves a big problem in endoscopic surgery. Knotting endoscopically is difficult, and takes a great deal of practice. Bleeders are difficult to tie off; the procedure is awkward and time-consuming. Quik-Stitch^® is a good solution to suturing problems," says Dr. Felix.

Robert T. Sewell, M.D., endoscopic surgeon, Colleyville, TX, says, "Suturing endoscopically is like tying shoelaces with chop sticks. Surgery is, and always has been, cutting and sewing. Laparoscopic surgical techniques have been trying to do something different to accommodate the constraints of working through instruments, substituting clips for sutures for example. As a result, surgeons lost control of their work. The security of good suturing cannot be replaced by clips. Surgeons know this. The PARE Surgical, Inc. Quik-Stitch^® is the first suturing device that addresses knot-making and placement directly. Even though I am proficient at endosopic suturing, I use the Quik-Stitch^® in many situations. I can save time using Quik-Stitch^®, and since shortened O.R. time is one of the benefits of endoseopic surgery, saving operative time is an important issue."

New techniques required to work within the confines of the endoscope make fundamental changes in procedures, forcing surgeons to adapt techniques at which they were adept in traditional surgery. Using the Quik-Stitch^® Endoscopic Suturing System, surgeons can return to the security of sewing as well as cutting, with real and familiar suturing materials.

Says Dr. Sewell, "Other stitching devices have been introduced earlier, but did not make knots. The development of the Quik- Stitch^® meets a pressing need in endoscopic surgery. With the advent of endoscopic suturing products that really work, surgeons who had been held back in procedures they would undertake through minimally invasive approaches will be able to increase the range of procedures they do endoscopically."