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Knot integrity using different suture types and different knot-tying techniques for reconstructive pelvic floor procedures

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Abstract

Introduction and hypothesis

Surgeons use a variety of sutures and knot-tying methods during pelvic reconstructive procedures. We hypothesized that knot-strength integrity will be similar with regards to type of knot, type of suture, and the knot-tying process.

Methods

Using six different suture materials, flat square knots and slip knots were tied robotically and by hand by two surgeons. Knot integrity was evaluated using an Instron 5544 machine. We measured force and elongation at suture failure or knot slippage (whichever came first) as well as force at 3-mm displacement.

Results

Four hundred and thirty-two knots were tie; one unraveled before the analysis, and 431 were tested. Three hundred and ninety-two knots reached or surpassed tensile strength of 30 N, the force at which tissue itself will fail. Knots tied with polyglyconate suture achieved the greatest tensile strength and those with OO-polydioxanone had the lowest. Hand-tied knots, regardless of technique and suture material, had greater tensile strength but greater elongation than robotically tied knots. Slip knots and flat square knots have similar integrity regardless of the tying technique.

Conclusion

Hand-tied knots had greater tensile strength than robotic knots, but the strength to break all knots required supraphysiological conditions. The decision to use a specific type of suture based on strength is not supported by our results, suggesting that surgeons may choose sutures based on other characteristics and personal comfort.

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Authors and Affiliations

  1. Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery Division, University of Massachusetts Medical School, Worcester, MA, USA

    Omar F. Dueñas-Garcia, Gina M. Sullivan, Katherine Leung & Michael K. Flynn

  2. University of Massachusetts – UMass Memorial Medical Center, 119 Belmont Street, Worcester, MA, 01605, USA

    Gina M. Sullivan, Katherine Leung & Michael K. Flynn

  3. Biomedical Engineering Department, Worcester Polytechnic Institute, 100 Institute Road Office 4007 Gateway Park, Worcester, MA, 01609, USA

    Kristen L. Billiar

Authors
  1. Omar F. Dueñas-Garcia
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  2. Gina M. Sullivan
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  3. Katherine Leung
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  4. Kristen L. Billiar
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  5. Michael K. Flynn
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Correspondence to Omar F. Dueñas-Garcia.

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Dueñas-Garcia, O.F., Sullivan, G.M., Leung, K. et al. Knot integrity using different suture types and different knot-tying techniques for reconstructive pelvic floor procedures. Int Urogynecol J 29, 979–985 (2018). https://doi.org/10.1007/s00192-017-3393-5

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  • DOI: https://doi.org/10.1007/s00192-017-3393-5

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