Hand suturing is one of the most challenging tasks in laparoscopic surgery and requires high cognitive effort from the performing surgeon. Nevertheless, it is also one of the basic skills of minimally invasive surgery and it is a critical skill due to its high requirements and broad application.

During gastric bypass surgery, there are multiple moments of hand suturing which makes the procedure physically and cognitively challenging. This research focuses on possible alternatives for internal tissue closure to reduce the frequency of hand suturing. The main objective of the research was to develop a method which reduces cognitive effort and procedure time while enhancing comfort for the surgeon.

To get insights into the current procedure of hand suturing, it was analysed on the example of anastomosis closure. Observations of gastric bypass surgeries gave the required information to generate a detailed workflow which identified hand suturing as a key difficulty during the process. The analysis results gave a starting point for the ideation of a new closure method. Additionally, requirements for the closure method were formulated and taken into account during the development.

Multiple concepts like differently shaped clips, hooks and staples were created and prototypes were built. Materials like metal wire staples and 3D printed prototypes were used and tested on foam, silicon and rubber. Through tests and interviews with healthcare professionals, one concept could be chosen and further detailed.

The newly developed method combines the advantages of both hand suturing and the commonly used stapling technique. The staples are attached in an alternating way on the edge of the tissues, while a suture is pre-threaded through the staples. When pulling the suture, the two sides approximate each other. The advantage of this method is that the tissue does not need to be positioned before the application which makes the procedure less challenging for surgeons.

A real scale prototype of the method was build to test manufacturability and proof of principle. Further optimization was done with Finite Element analysis and co-creation sessions with medical doctors. The evaluation of the concept was done in close collaboration with multiple bariatric surgeons, by conducting interviews and hosting discussion sessions.

The result of the evaluation showed that some of the safety requirements on anastomosis closure cannot be met with the newly developed concept. More suitable alternatives like the closure of mesenteric windows was investigated. Mesentery defects occur e.g. due to anatomic changes during gastric bypass surgery. If left untreated they may lead to internal hernia and small bowel obstruction. The newly developed method has the potential to close mesenteric windows time efficiently while enhancing the surgeon’s comfort. Risk assessment and further interviews showed that this application is safer and more accepted by surgeons which makes it a promising solution for hernia repair.