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ssss1 Pistol grip laparoscopic needle driver.

Source: © 2014 Photo courtesy of KARL STORZ GmbH & Co. KG.

ssss1 Needle driver with handle designed for thumb–ring finger grip. These did not perform as well as other designs.

Source: © 2014 Photo courtesy of KARL STORZ GmbH & Co. KG.

ssss1 For novice laparoscopic surgeons, we recommend needle drivers that are sturdy, with straight handles, ribbed grips, and conveniently located needle release buttons on the grips.

Source: © 2014 Photo courtesy of KARL STORZ GmbH & Co. KG.

ssss1 Different configurations of needle driver jaws. From top to bottom: “parrot jaw” curved left, “flamingo jaw” curved right for a 6‐mm cannula, and “flamingo jaw” curved right for an 11‐mm cannula.

Source: © 2014 Photo courtesy of KARL STORZ GmbH & Co. KG.

Conventional suture materials are routinely used in MIS, especially for interrupted sutures or ligatures. Braided synthetic absorbable sutures are often favored over monofilament synthetic absorbable sutures for intracorporeal suturing. The primary reason for this preference is the ease of handling that follows from the decreased memory of braided versus monofilament sutures. Furthermore, braided sutures are more resistant to instrument-induced damage during the knotting process. As knots are formed, there is significant interstrand friction, commonly known as chatter. This friction can induce significant damage to suture materials, particularly monofilaments. Braided materials are less vulnerable to this damage because their strength is distributed over many fibers similar to the cables of a suspension bridge. Braided materials are not without their downside, however. They have considerably more tissue drag than monofilament sutures, and they can harbor and potentiate bacterial infections. To minimize these effects, suture manufacturers have devised two solutions. First, application of coating agents, such as caprolactone and calcium stearate, fills in the gaps in the interstices of the braid and decreases friction during tissue passage. Second, some manufacturers use antimicrobial coatings on their materials to preemptively address suture-potentiated infections.