Covidien Endo Stitch User manual

Endo Stitch™
Suturing Instrument Intracorporeal Knot Tying Manual

Introduction..........................................................................1
Instructions for Use ....................................................................2
Loading the Instrument.................................................................5
Unloading the Instrument ...............................................................7
KNOT TYING TECHNIQUES
Square Knot..........................................................................8
Surgeon’sSquareKnot ................................................................10
ModifiedFisherman’sKnot.............................................................12
Tail Spin Knot - Alt. Square Knot .........................................................14
Securing a Running Stitch ..............................................................16
Order Codes.........................................................................17
This manual will help you to gain an understanding of basic intracorporeal knot-tying
techniques using the Covidien Endo Stitch™Suturing Instrument. The manual includes
instructions for use of the instrument, as well as instructions for loading and following
the step-by-step instructions, and with just a little practice, this manual will enable you
to master these time-saving techniques within a very short time.
Refer to the package insert for complete product details.
Acknowledgments:
Covidien wishes to acknowledge the contributions of Shelley D. Spray and J. Paul Nolan, ASME, IDSA, SAE for the
editorial content of the Endo Stitch™Suturing Instrument Intracorporeal Knot Tying Manual. In addition, we thank
J. Paul Nolan and Cindy Zacks for their illustrations.
TABLE OF CONTENTS

The Covidien Endo Stitch™suturing instrument is designed to make endoscopic suturing
and the tying of intracorporeal knots easy. The Endo Stitch™suturing device, with its
integral needle and suture, will make it possible for you to undertake most endoscopic
procedures without the necessity of having to struggle with loose needles and suture.
A wide range of available suture materials makes the Endo Stitch™instrument suitable
for use in most endoscopic procedures requiring suturing. All needles and sutures are
housed in convenient to use cartridges, ready for instant loading.
The shaft of the Endo Stitch™10mm instrument is 36cm in length to provide enhanced
access to the tissue site.
The large 4mm tissue gap, combined with the jaw’s ability to compress tissue, allows
the Endo Stitch™instrument to accommodate a wide variety of tissue thicknesses,
varying between thin, delicate tissue, to tissue thickness requiring the application
of a 4.8mm staple.
The jaws of the Endo Stitch™instrument are 4mm wide. To further assist in placing
the needle as close to the tissue as possible, the needle is offset to one side of the
jaws. The needle is closest to the edge of the jaw that is on the side of the instrument
bearing the Autosuture logo.
The needle which is used with the Endo Stitch™instrument is taper pointed on both
ends. This double-pointed needle, utilizing taper points, assists in penetrating tissue.
INTRODUCTION
1mm
2mm
3mm
0.9mm
9mm
LOCKING
SLOT
| 1 |

Product Description
INSTRUCTIONS FOR USE
The handles of the instrument are designed to fit
comfortably into the user’s hands.
The handle section consists of two toggle levers,
two black unloading buttons (one on the front
and one on the back) and two handles.
The handles are fully squeezed to close the jaws
and are released to open the jaws. Adjust the
amount that the jaws are opened by simply varying
the amount that the handles are squeezed. This
allows for enhanced access to tight operative sites.
The needle is passed back and forth between the
instrument’s jaws by completely squeezing the
handles and activating either toggle lever forward
or backward. (If a suture and needle are not loaded
into the instrument, the suture can be loaded into
the jaws by following the loading instructions.)
JAWS SHAFT
TOGGLE
LEVERS
RELOADING
BUTTONS ARROWS HANDLES
Schematic View and Nomenclature
| 2 |

Before inserting the instrument
into the trocar, the jaws must
be placed in the closed, neutral
position. To align the jaws in the
neutral position, the handles are
completely squeezed, and the
toggle levers are aligned with
the arrows on the instrument
body. The jaws are now ready
to be inserted into the trocar.
Once the instrument has been
inserted through the trocar,
the handles are squeezed and
either toggle lever is moved
completely forward or backward.
Once the needle has
been completely pulled
through the tissue, the jaws
of the instrument should
be returned to the closed,
neutral position. The closed,
neutral position should be
used any time that the
surgeon is pulling the
suture through tissue.
To pass the needle
through tissue, the jaws
of the Endo Stitch™
instrument must first be
placed in the open position
(i.e., either toggle lever is
activated to the forward
position). Note: The needle
is always in the jaw on the
side which has the toggle
lever pushed forward.
Once the jaws are fully
closed, either toggle lever
is activated completely
forward or backward
(depending on their
original position) and
the needle is passed from
one jaw to the other jaw.
As the handles are
released, the jaws open,
and the needle is gently
pulled through the tissue.
The handles are then
released and the jaws
are opened, exposing the
needle. The instrument is
now ready to place a stitch.
The tissue to be sutured
is exposed by using an
Endo Grasp™instrument.
The jaws of the instrument
are placed around the
tissue to be sutured.
The handles are
completely squeezed
to close on the tissue.
| 3 |

Neutral Position
The neutral position provides three important advantages.
•First, it allows the jaws of the instrument to be easily inserted into the trocar.
•Second, it protects both needle tips from inadvertently puncturing tissue.
Neutral Position
Open Position
| 4 |
INSTRUCTIONS FOR USE (Continued)
•Third, the neutral position fully supports the needle. If the jaws are not in the neutral
position and you pull on the suture, you may run the risk of having the needle bend.
You may also risk pulling the needle out of alignment with the empty hole located on
the opposite jaw. If the needle is not properly aligned or the needle is bent, the jaws
may not close, and the needle may need to be unloaded and retrieved manually.

First ensure that the jaws are in the open position with
the metal bars fully extended. The teal toggle levers
should be in a forward position and the red indicator
boxes should be fully exposed.
LOADING THE INSTRUMENT
To Load
STEP 1
Insert the jaws into the single use loading unit (SULU)
with the Autosuture™logo facing up. Press down at the
apex of the jaws to ensure that the jaws are fully seated.
If the instrument is not in the ready to load position (i.e.,
the metal bars are not exposed), follow the instructions
to unload the instrument (even if there is no needle in
the jaws) to expose the metal bars.
RED INDICATOR
BOX
TEAL TOGGLES
APEX OF JAWS
| 5 |
METAL
BARS

STEP 2
Completely squeeze the handles together with one
hand while using the other hand to pull both toggle
levers back from the jaws until an audible click indicates
that the needle is properly loaded. Note that the red
indicator boxes are covered by the black button.
STEP 3
Gently press down on the tab located at the top of
the SULU. The jaws will release from the SULU. Pull the
SULU away from the jaws to unreel the suture from the
spool. When using longer lengths of suture, ensure that
the suture does not fall from the sterile field. Suture
SULUs are offered in 7" and 48"; other lengths can
be manually cut.
Test to ensure that the needle is fully seated by
passing the needle back and forth between the jaws
of the instrument. The instrument is now ready for
use. (If the needle does not pass smoothly, unload
the needle and reload.)
INDICATOR
BOXES
| 6 |
LOADING THE INSTRUMENT (Continued)

To Unload
UNLOADING THE INSTRUMENT
STEP 3
Keeping the jaws of the instrument over a suitable
needle disposal site, release the handles and remove
the needle. The Endo Stitch™instrument is now ready
to be reloaded.
STEP 2
Keeping the handles squeezed together, simultaneously
press the two black reloading buttons which are located
on the front and rear of the instrument. Slide the buttons
forward, exposing the red indicator boxes marked on the
body of the instrument.
STEP 1
Squeezing the handles together, align the toggle levers
with the arrows on the body of the handles.
ARROWS
TOGGLES
ALIGNED
BLACK
BUTTONS
INDICATOR
BOXES
| 7 |

KNOT TYING TECHNIQUES - SQUARE KNOT
STEP 1
Pass the sutured needle
through the tissue.
STEP 2
Lay the suture which
extends directly from
the needle over the top
of the empty jaw.
STEP 3
Grasp the suture tail with an
Endo Grasp™instrument. Bring
the suture tail in between the
jaws of the instrument. Close
the jaws and pass the needle.
STEP 4A-4B
Pull the jaw with the
needle back through
the loop of suture.
| 8 |

STEP 6
Return the same toggle
lever back into the forward
position. The needle should
be in the same jaw as in
step 4a - 4b (the left jaw).
STEP 5
Cinch the knot with
the jaws in the closed
neutral position.
STEP 10
Cinch the knot with
the jaws in a closed
position. Repeat steps to
place additional throws.
STEP 9
Pull the jaw with the
needle back through
the loop of suture.
STEP 8
Bring the suture tail in
between the jaws of the
instrument. Close the jaws
and pass the needle.
STEP 7
Lay the suture which
extends directly from
the needle over the
top of the empty jaw.
| 9 |

KNOT TYING TECHNIQUES - SURGEON’S SQUARE KNOT
STEP 1
Pass the sutured needle
through tissue.
STEP 2
Close the jaws and
transfer the needle
to the opposite jaw.
STEP 3
Lay the suture which
extends from the
needle over the top
of the empty jaw.
STEP 4
Bring the suture tail
in between the jaws
of the device. Close the
jaws and pass the needle
to the opposite jaw.
STEP 5
Bring the suture tail
in between the jaws
of the device. Close the
jaws and pass the needle
to the opposite jaw.
| 10 |

STEP 7
Pull the jaw with the
needle back through
the loop.
STEP 6
Place the empty jaw in the
loop adjacent to the tissue.
Close the jaws and pass the
needle to the opposite jaw.
STEP 9
To complete the
Surgeon’s Knot Square,
continue with a single
throw of the Square Knot.
STEP 8
With the jaws in the
closed neutral position,
cinch the knot tight.
| 11 |

STEP 1
Pass the sutured needle
through the tissue.
KNOT TYING TECHNIQUES - MODIFIED FISHERMAN’S KNOT
STEP 6
Pull the jaw back
out from the loop.
STEP 5
Pass the needle to
the opposite jaw.
STEP 4
Insert the empty jaw
into the loop adjacent
to the tissue.
STEP 3
Pull the tail in between the
jaws just behind the needle.
STEP 2
Pick up the tail of suture
with the Endo Grasp™
instrument. Pass the
needle to opposite jaw.
| 12 |

STEP 7
Insert the empty jaw into the
loop adjacent to the tissue.
STEP 11
To secure and tie off this
Modified Fisherman’s Knot,
use a single throw of the
Square Knot.
STEP 10
Tighten the knot with the
jaws closed and the toggle
levers in the neutral position.
STEP 9
Pull the jaw back out
from the loop needle.
STEP 8
Pass the needle to
the opposite jaw.
| 13 |

STEP 1
Pass the sutured needle
through the tissue.
KNOT TYING TECHNIQUES - TAIL SPIN KNOT: ALT. SQUARE KNOT
STEP 6
Cinch the knot with the
jaws in the closed and
neutral position.
STEP 5
Pull the jaw with the needle
out of the tail suture loop.
STEP 4
Pass the needle to
the opposite jaw.
STEP 3
Wrap suture tail once
around the empty
jaw (jaw without needle).
STEP 2
Bring the tail in
between the jaws.
| 14 |

STEP 12
To create a Surgeon’s Knot:
At step 3 only, wrap the tail
suture around the empty
jaw twice instead of once.
STEP 7
Bring the tail in between
the open jaws (needle in
the same jaw as in step 5).
STEP 8
Wrap the suture once
around the empty jaw.
STEP 9
Pass the needle to
the opposite jaw.
STEP 10
Pull the jaw with the needle
out of the tail suture loop.
STEP 11
Cinch the knot with the
jaws closed and in the
neutral position.
| 15 |

STEP 5
Tie off the Modified
Fisherman’s Knot using
a single throw of the
Square Knot.
STEP 4
Holding the loop
with the Endo Grasp™
instrument, use this as
a tail to terminate the
run with a Modified
Fisherman’s Knot
(see p. 12).
STEP 3
At the end of the running
stitch, make the last pass
through the tissue close
to the penultimate pass.
The loop that this last pass
forms can be now held
up with an Endo Grasp™
instrument to make a tail
for tying off the run.
STEP 2
Anchor the starting
point by tying a Square
Knot (see p. 11). Run the
desired length of stitches.
STEP 1
Pass the sutured needle
through the tissue. Pull
enough suture material
through the tissue to
ensure there is sufficient
material to make the run
of stitches, and to tie off the
knot at the end of the run.
KNOT TYING TECHNIQUES - SECURING A RUNNING STITCH
| 16 |

Endo Stitch™Single Use Loading Units - Single Stitch
Order
Code Suture Type Description Size
Usp=Size Metric Color Length
170051 Polysorb™Ctd, Brd Lactomer™9-1 2-0 3 Violet 7" 18cm
170053 Polysorb™Ctd, Brd Lactomer™9-1 2-0 3 Violet 48" 120cm
170050 Polysorb™Ctd, Brd Lactomer™9-1 0 3.5 Violet 7" 18cm
170052 Polysorb™Ctd, Brd Lactomer™9-1 0 3.5 Violet 48" 120cm
170056 Polysorb™Ctd, Brd Lactomer™9-1 0 3.5 Undyed 48" 120cm
170054 Polysorb™Ctd, Brd Lactomer™9-1 0 3.5 Undyed 7" 18cm
170057 Polysorb™Ctd, Brd Lactomer™9-1 2-0 3 Undyed 48" 120cm
170055 Polysorb™Ctd, Brd Lactomer™9-1 2-0 3 Undyed 7" 18cm
170070 Polysorb™Ctd, Brd Lactomer™9-1 3-0 2 Violet 7" 18cm
170071 Polysorb™Ctd, Brd Lactomer™9-1 3-0 2 Violet 48" 120cm
170072 Polysorb™Ctd, Brd Lactomer™9-1 3-0 2 Undyed 7" 18cm
170073 Polysorb™Ctd, Brd Lactomer™9-1 3-0 2 Undyed 48" 120cm
170090 Polysorb™Ctd, brd Lactomer™9-1 4-0 1.5 Violet 48" 120cm
170092 Polysorb™Ctd, Brd Lactomer™9-1 4-0 1.5 Violet 7" 18cm
170094 Polysorb™Ctd, Brd Lactomer™9-1 4-0 1.5 Undyed 7" 18cm
170096 Polysorb™Ctd, Brd Lactomer™9-1 4-0 1.5 Undyed 48" 120cm
170012 Bralon™Ctd, Brd Nylon 0 3.5 Black 48" 120cm
170010 Bralon™Ctd, Brd Nylon 0 3.5 Black 7" 18cm
170013 Bralon™Ctd, Brd Nylon 2-0 3 Black 48" 120cm
170011 Bralon™Ctd, Brd Nylon 2-0 3 Black 7" 18cm
170003 Sofsilk™Ctd, Brd Silk 0 3.5 Black 48" 120cm
170001 Sofsilk™Ctd, Brd Silk 0 3.5 Black 7" 18cm
170004 Sofsilk™Ctd, Brd Silk 2-0 3 Black 48" 120cm
170002 Sofsilk™Ctd, Brd Silk 2-0 3 Black 7" 18cm
173026 Surgidac™Ctd, Brd Polyester 0 3.5 Green 7" 18cm
173024 Surgidac™Ctd, Brd Polyester 0 3.5 Green 48" 120cm
173021 Surgidac™Ctd, Brd Polyester 2-0 3 Green 7" 18cm
173023 Surgidac™Ctd, Brd Polyester 2-0 3 Green 48" 120cm
ORDER CODES
Endo Stitch™Single Use Loading Units - Triple Stitch
Order
Code Suture Type Description Size
Usp=Size Metric Color Length
170043 Surgidac™Ctd, Brd Polyester 0 3.5 Green 48" 120cm
170040 Surgidac™Ctd, Brd Polyester 0 3.5 Green 7" 18cm
170041 Surgidac™Ctd, Brd Polyester 2-0 3 Green 7" 18cm
170044 Surgidac™Ctd, Brd Polyester 2-0 3 Green 48" 120cm
Endo Stitch™Suturing Devices
Order Code Instrument
173027 Endo Stitch™Short Suitable for Open Surgery
173016 Endo Stitch™10mm Suturing Device
OTHER SUGGESTED READING
COVIDIEN Knot Tying Manual
Richard R. Edlich, MD, PhD
Laparoscopic Suturing:
A Fast and Easy New Technique
Nelson H. Stringer, MD, Contemporary OB/GYN
Available from your Covidien
Surgical Device Specialist
PLEASE REFER TO THE PACKAGE INSERT FOR COMPLETE INSTRUCTIONS, INDICATIONS, CONTRADICTIONS, WARNINGS AND PRECAUTIONS
Triple
Stitch
SULU
Single
Stitch
SULU
Suturing Device

150 Glover Avenue
Norwalk, CT
06856
www.covidien.com
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