Laparoscopic intracorporeal knot tying using a novel device

Abstract

Background

Laparoscopic intracorporeal knot tying has traditionally been considered the most difficult skill in laparoscopic surgery. We developed a novel device for assisting laparoscopic intracorporeal knotting that transforms a pre-tied slip knot into a secure double sheet bend. The aim of this study is to check the feasibility of using this novel device to assist in performing laparoscopic knot tying.

Methods

We used a laparoscopic trainer with a piece of plastic artificial skin as an experimental model. Twenty laparoscopic device-assisted double sheet bends (experimental group) and 20 traditional laparoscopic two-turn flat square knots (control group) were performed in random order. After cutting the loop and the ends of each knot, all 40 knotted threads and an additional eight unknotted threads were transferred to a tensiometer to test their strength using the single-strand method. Post-knotting variables of the two groups were compared.

Results

Knot strength (mean ± standard deviation) did not differ between the two groups (experimental group: 2.26 ± 0.50 kg vs. control group: 2.03 ± 0.94 kg; P = 0.51). The knot efficiencies of the experimental and control group were 60.6 and 54.4% (P = 0.51), respectively. However, the experimental group had a lower knot failure rate (5 vs. 40%, P = 0.02) and shorter knotting time (37.0 ± 9.2 vs. 107.0 ± 47.7 s, P < 0.001) compared with the control group.

Conclusions

This novel device significantly shortened the knotting time of laparoscopic intracorporeal knot tying, and did not compromise the success rate or strength of the knot.

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References

  1. 1.

    James H, Dorsy C, Tabb R, Zucker KA (2001) Laparoscopic suturing and knot tying. In: Zucker KA, Bailey RW, Reddick EJ (eds) Surgical laparoscopy update. Lippincott Williams and Wilkins, Philadelphia, pp 75–95

    Google Scholar 

  2. 2.

    Pattaras JG, Smith GS, Landman J, Moore RG (2001) Comparison and analysis of laparoscopic intracorporeal suturing devices: preliminary results. J Endourol 15:187–192

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Tan A, Razvi H (2005) Evaluation of a novel modified suture material designed to facilitate intracorporeal knot tying during laparoscopic surgery. J Endourol 19:1104–1108

    PubMed  Article  Google Scholar 

  4. 4.

    Jernigan SR, Chanoit G, Veeramani A, Owen SB, Hilliard M, Cormier D, Laffitte B, Buckner G (2010) A laparoscopic knot-tying device for minimally invasive cardiac surgery. Eur J Cardiothorac Surg 37:626–630

    PubMed  Article  Google Scholar 

  5. 5.

    Bermas H, Fenoglio M, Haun W, Moore JT (2004) Laparoscopic suturing and knot tying: a comparison of standard techniques to a mechanical assist device. JSLS 8:187–189

    PubMed  Google Scholar 

  6. 6.

    Nouira Y, Horchani A (2001) The pre-looped intracorporeal knot: a new technique for knot tying in laparoscopic surgery. J Urol 166:195–197

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Asao T, Yamaguchi S, Tsutsumi S, Mochiki E, Kuwano H (2007) Experimental results and early clinical experience with an easy method for intracorporeal knot tying using a novel laparoscopic needleholder. Surg Endosc 21:1553–1556

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Chi T, Eisner BH, Berger AD, Stoller ML (2010) An ex-vivo evaluation of the application and strength of a novel laparoscopic knot substitute device. J Endourol 24:95–98

    PubMed  Article  Google Scholar 

  9. 9.

    Akl MN, Long JB, Giles DL, Cornella JL, Pettit PD, Chen AH, Magtibay PM (2009) Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc 23:2390–2394

    PubMed  Article  Google Scholar 

  10. 10.

    Trimbos JB (1984) Security of various knots commonly used in surgical practice. Obstet Gynecol 64:274–280

    PubMed  CAS  Google Scholar 

  11. 11.

    Tera H, Aberg C (1977) Strength of knots in surgery in relation to type of knot, type of suture material and dimension of suture thread. Acta Chir Scand 143:75–83

    PubMed  CAS  Google Scholar 

  12. 12.

    Tera H, Aberg C (1976) Tensile strengths of twelve types of knot employed in surgery, using different suture materials. Acta Chir Scand 142:1–7

    PubMed  CAS  Google Scholar 

  13. 13.

    Treasure T (2002) Surgeons’ knots: old skills, new training. Lancet 359:642

    PubMed  Article  Google Scholar 

  14. 14.

    Dorsey JH, Sharp HT, Chovan JD, Holtz PM (1995) Laparoscopic knot strength: a comparison with conventional knots. Obstet Gynecol 86:536–540

    PubMed  CAS  Google Scholar 

  15. 15.

    Sharp HT, Dorsey JH, Chovan JD, Holtz PM (1996) The effect of knot geometry on the strength of laparoscopic slip knots. Obstet Gynecol 88:408–411

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Visser JD (1980) Dynamic strength of surgical suture materials. In: Winter GD, Leray JL, de Groot K (eds) Evaluation of biomaterials. Wiley, London, pp 269–274

    Google Scholar 

Download references

Acknowledgment

This study was supported by a grant from Far Eastern Memorial Hospital (FEMH-99-B-001).

Disclosures

Author Fung-Chao Tu is the inventor of this novel device. Authors Wen-Yih Wu, Ho-Hsiung Lin, and Sheng-Mou Hsiao have no conflicts of interest or financial ties to disclose.

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Correspondence to Sheng-Mou Hsiao.

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Tu, FC., Wu, WY., Lin, HH. et al. Laparoscopic intracorporeal knot tying using a novel device. Surg Endosc 26, 872–876 (2012). https://doi.org/10.1007/s00464-011-1971-z

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Keywords

  • Laparoscopic intracorporeal knot tying
  • Device-assisted knot tying
  • Double sheet bend
  • Two-turn flat square knot