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Introduction <p>Adequate aponeurotic closure is essential to reduce postoperative complications, particularly incisional hernia. However, maintaining guideline-recommended closure principles such as a suture length-to-wound length (SL/WL) ratio ≥ 4 can be technically demanding and is often performed at the end of long procedures. The SutureTOOL is a handheld device designed to standardize stitch placement, facilitate SL/WL ≥ 4, and potentially reduce operator workload.</p> Methods <p>Sixteen physicians (8 residents, 8 surgeons) performed eight 12-cm aponeurosis closures on silicone models using either the SutureTOOL or a traditional needle driver, under guided and unguided conditions. Upper-limb kinematics and muscle activity were assessed with motion capture and surface electromyography. Primary outcomes were cumulative joint angular displacement (°), integrated muscle activation (%MVC × s), and mean muscle activation per cycle (%MVC). Secondary outcomes included cycle duration, SL/WL ratio, and user evaluation. Exploratory analyses assessed guidance and surgical experience effects.</p> Results <p>Compared with the needle driver, the SutureTOOL reduced joint displacement across most degrees of freedom, except right shoulder abduction/adduction. Integrated muscle activation was generally lower or equivalent, except for higher right trapezius activity. Cycle duration was shorter with the SutureTOOL (7.5 vs. 10.4&#xa0;s; <i>p</i> &lt; 0.001). The SL/WL ratio was higher with the device (5.03 vs. 4.65; <i>p</i> = 0.005), indicating improved adherence to closure guidelines. User satisfaction was high in ergonomics, learning, and efficiency domains. No major differences were observed between residents and experts, while free sutures were less demanding than guided sutures.</p> Conclusion <p>The SutureTOOL reduced distal joint displacement and overall integrated muscle workload over time while improving closure reproducibility, including higher SL/WL ratios, and shortening cycle duration. Its intuitive use and short learning curve support potential applications in surgical practice and education.</p>

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Ergonomic evaluation of a novel suturing device (SutureTOOL) versus traditional needle-driver for aponeurotic closure: a randomized experimental study

  • 期刊论文

  • 发表日期：

    2026年2月11日

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  • Diane Bernard de Lajartre,
  • Vincent Dochez,
  • Aurélie Sarcher,
  • Thibault Thubert

摘要

Introduction

Adequate aponeurotic closure is essential to reduce postoperative complications, particularly incisional hernia. However, maintaining guideline-recommended closure principles such as a suture length-to-wound length (SL/WL) ratio ≥ 4 can be technically demanding and is often performed at the end of long procedures. The SutureTOOL is a handheld device designed to standardize stitch placement, facilitate SL/WL ≥ 4, and potentially reduce operator workload.

Methods

Sixteen physicians (8 residents, 8 surgeons) performed eight 12-cm aponeurosis closures on silicone models using either the SutureTOOL or a traditional needle driver, under guided and unguided conditions. Upper-limb kinematics and muscle activity were assessed with motion capture and surface electromyography. Primary outcomes were cumulative joint angular displacement (°), integrated muscle activation (%MVC × s), and mean muscle activation per cycle (%MVC). Secondary outcomes included cycle duration, SL/WL ratio, and user evaluation. Exploratory analyses assessed guidance and surgical experience effects.

Results

Compared with the needle driver, the SutureTOOL reduced joint displacement across most degrees of freedom, except right shoulder abduction/adduction. Integrated muscle activation was generally lower or equivalent, except for higher right trapezius activity. Cycle duration was shorter with the SutureTOOL (7.5 vs. 10.4 s; p < 0.001). The SL/WL ratio was higher with the device (5.03 vs. 4.65; p = 0.005), indicating improved adherence to closure guidelines. User satisfaction was high in ergonomics, learning, and efficiency domains. No major differences were observed between residents and experts, while free sutures were less demanding than guided sutures.

Conclusion

The SutureTOOL reduced distal joint displacement and overall integrated muscle workload over time while improving closure reproducibility, including higher SL/WL ratios, and shortening cycle duration. Its intuitive use and short learning curve support potential applications in surgical practice and education.