Endoscopic surgery presents a constrained working environment for surgeons
Surgeons must deal with realities of long instruments and awkward angle
Suturing is probably the most difficult and time consuming of all MIS tasks
Align Step
Aim is to ensure needle is aligned correctly before and after puncture
Composed of four substeps, numbered 1-4.
Bite Step
Ideal trajectory is a circle with radius equal to needle radius
This step is formulated as substep 5.
Can be performed at awkward angles
Avoids multiple trials and large undesirable movements inside tissue.