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Tensile strength and failure load of sutures for robotic surgery

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Abstract

Background

Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595–600, 1985. doi:10.1002/jbm.820190511). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1–6, 2014. doi:10.1097/SLA.0b013e3182a5c8b8). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force.

Methods

Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements.

Results

Generally, Vicryl and PDS sutures had the highest mechanical strength (47–179 kN/cm2), while Silk had the lowest (40–106 kN/cm2). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27–50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389–1402, 2002. doi:10.1007/s00464-001-8283-7). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture.

Conclusions

Availability of suture tensile strength and failure load data will help define software safety protocols for alerting a surgeon prior to suture failure during robotic surgery. Awareness of suture strength weakening with direct instrument manipulation may lead to the development of better techniques to further reduce intraoperative suture breakage.

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Acknowledgements

This research was partially supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health under Award Number R01EB019473-01. We thank our colleagues who provided insight and expertise that greatly assisted the research.

Disclosures

Dr. Erik Duston is on Scientific Advisory board of Titan Medical. Ahmad Abiri, Dr. Omeed Paydar, Anna Tao, Megan LaRocca, Kang Liu, Dr. Bradley Genovese, Dr. Robert Candler, and Dr. Warren Grundfest have nothing to disclose.

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Authors and Affiliations

  1. UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA

    Ahmad Abiri, Omeed Paydar, Anna Tao, Megan LaRocca, Kang Liu, Bradley Genovese, Robert Candler, Warren S. Grundfest & Erik P. Dutson

  2. UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA

    Ahmad Abiri, Omeed Paydar, Robert Candler & Warren S. Grundfest

  3. UCLA Department of Surgery, Los Angeles, CA, USA

    Bradley Genovese & Erik P. Dutson

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  1. Ahmad Abiri
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  2. Omeed Paydar
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Corresponding author

Correspondence to Ahmad Abiri.

Appendix

Appendix

See Tables 5, 6, 7 and 8.

Table 5 Statistical analysis of Table 1 failure load data using t test
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Table 6 Statistical analysis of Table 1 tensile strength data using t test
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Table 7 Statistical analysis of Table 2 data using t test
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Table 8 Statistical analysis of Table 4 data using t test
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Abiri, A., Paydar, O., Tao, A. et al. Tensile strength and failure load of sutures for robotic surgery. Surg Endosc 31, 3258–3270 (2017). https://doi.org/10.1007/s00464-016-5356-1

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