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Page 4 of 8 Lesch et al. Mini-invasive Surg 2023;7:20 https://dx.doi.org/10.20517/2574-1225.2023.24

Table 1. Nomination system
Abbreviation Meaning
Tissue B: Bovine tissue
P: Porcine tissue
Test bench settings 120 /150 /180 /210 /240 Maximum pressure in mmHg
2
Cover plate sO Square opening, A = 256 cm
cO Circular opening, A = 490 cm 2
Defect IN Incision 15 cm
DC5 Defect circular 5 cm
INDC5 Incision + defect circular
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Materials MM 20 /1 Monomax USP 2-0 or 1
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PDS 20 PDS USP 2-0
Technical details SBu Small-stitch-small-bite unstandardized suturing
SBs Small-stitch-small-bite standardized suturing
LBu Large-stitch-large-bite unstandardized suturing
LBs Large-stitch-large-bite standardized suturing

investigated further influencing circumstances such as the standardization of the suture, a different suture
material, an additional defect, a larger impact area, or a lower peak pressure.

Figure 1 illustrates the comparison of unstandardized Small-Bite stitches vs. Large Bite stitches performed
with a USP 2/0 or USP 1 Monomax suture, closing midline incisions (ES 1 + 2, 5 + 6). 100% durability was
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obtained in all series, regardless of the stitch spacing, thread thickness, and tissue type.

The durability drops by 10%-50% when adding a circular defect into the incision and using the cover plate
with the larger opening. We used a standardized small-stitch-small-bite technique with USP 2/0 Monomax ®
or PDS sutures.
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The standardized small-bite Monomax suture (triangles) provided secure closure in 9 out of 10 experiments
[Figure 2]. It showed a 50% higher likelihood of secure closure (LOSC) (P = 0.064) than the PDS suture
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(dots).

Series 11-13 and series 14 + 15 had the same experimental setup, with a peak pressure of 210 mmHg or 180
mmHg. 30%-40% of the sutures held securely when exposed to 210 mmHg [Figure 3]. When the peak
pressure lowers by 30 mmHg, the LOSC rises by 20%-30%. Figure 4 the upper and lower graph show
differences in the durability between 200 and 400 DIS impacts due to the stochastic nature of the process.
The graphs converge at 425 impacts. This demonstrates the reproducibility of the process with 425
[15]
impacts .

DISCUSSION
The bench test we used allows the simulation of everyday loads on the abdominal wall. According to
modern biomechanics, the tissue and reconstruction need to be considered and assessed as a compound.

The durability of a suture closure does not solely depend on the accurate execution of one specific factor.
The interplay of the individual influencing factors determines the outcome of the suture closure of the
abdominal wall. This applies to any experimental and clinical setting. It is the base of the existing GRIP/
CRIP concept [19,20] . The standardized suture, used in ES 9 - 15, provides an instruction for secure suture