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In the early years of minimally invasive surgery (MIS), controversy existed regarding the need for suturing skills. Many practicing surgeons thought that laparoscopic suturing was too difficult to ever be considered a realistic requirement [1]. However, in the early 1990s, a consensus was built: laparoscopic surgeons had to learn and apply basic suturing skills unless the development of laparoscopic surgery was to be impeded. [2] As laparoscopic techniques advanced from ablative to reconstructive procedures, suturing skills became increasingly important [3]. Soon it was recognized that these complex skills had to be practiced with other methods than the classical “see one, do one, teach one” paradigm of conventional residency training. As a result, simulation training became a requirement. Despite an intense technological advancement, intracorporeal suturing remains of paramount importance to MIS surgeons to this day. Robotic technology has not circumvented the need for suturing. However, robotic wrist‐action and 3D vision have made suturing more intuitive to learn [4].

Currently, veterinary medicine is facing a similar dilemma. The introduction of MIS into small animal surgery has resulted in MIS technology being available at most specialized and many nonspecialized practices. For progressive evolution of small animal MIS, we need to embrace suturing techniques. Because of the challenge of suturing, many replacement devices have been introduced, but most are expensive and not always as versatile or secure as desired. With suturing skills, many open surgical techniques can be replaced with minimally invasive counterparts for the benefit of our patients. Having suturing skills also increases the surgeon's confidence to deal with emergent situations during a surgical procedure without the need for conversion to open surgery.

This chapter is intended to give novice laparoscopic surgeons a foundation, enabling them to start practicing suturing in a simulator in preparation for clinical application. With suturing skills developed in the simulator, we have found that the step to intracorporeal clinical suturing is small for most trainees.