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Several other ASDs exist, with a number of technical advancements made as more experience with ASDs has been gained. The RD‐180 (LSI Solutions, Victor, NY) is similar to the Endo Stitch and is used in concert with the Ti‐Knot Device (LSI Solutions, Victor, NY) and fastener to achieve adequate knot security. The RD‐180/Ti‐Knot device was found to be comparable to the Endo Stitch in surgical time and dehiscence rate when used for closure of the vaginal cuff during laparoscopic hysterectomy in women [26]. This device has not yet been described in the veterinary literature.

Further advancement in ASDs came with the development of roticulating devices. Roticulating devices offer the advantage of increased dexterity when working space is limited and multiple instruments may be in close proximity to the telescope. The SILS (single incision laparoscopic surgery) Stitch (Covidien, Mansfield, MA; ssss1) is essentially a roticulating version of the EndoStitch for use with the SILS system, which is described elsewhere in this textbook. The SILS Stitch has successfully been used with barbed suture for laparoscopic gastropexy in dogs [27, 28]. When the SILS Stitch was compared to conventional intracorporeal sutured laparoscopic gastropexy using barbed suture, there was no difference in surgical time [28], suggesting that the added dexterity of the SILS Stitch may not necessarily translate into shorter surgical time. Other roticulating ASDs include the Proxisure (Ethicon, Summerville, NJ) and the Endo360 (Endoevolution, Raynham, MA), which use a curved needle in lieu of a straight needle. A curved needle may create less tissue trauma than a straight needle during needle passage. The most advanced innovation in ASDs has been the development of the Endosew (Karl Storz, Tuttlingen, Germany), which creates running sutures during robot‐assisted laparoscopic surgery [29, 30]. It has been used experimentally to create a U‐shaped ileal neobladder in a porcine model [30], but its use in veterinary medicine has not yet been reported.