Abstract
Background
Microvascular surgery requires fine finger movements with stabilised hands for successful anastomosis. Limited space in deeper locations, such as the interhemispheric fissure, increases the difficulty in placing the knots during microvascular suturing.
Methods
This note describes a novel technique of constructing reef knots. The technique reduces the excursions of the instrument tips while knotting.
Conclusions
Using this knotting technique in deep microvascular suturing improves the ergonomic ease and stability of knots, while working in deep locations through narrow corridors.
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References
Coulson CJ, Slack PS, Ma X (2010) The effect of supporting a surgeon’s wrist on their hand tremor. Microsurgery. 30:565–568
Edlich RF, Long WB III (2008) Surgical knot tying manual (3rd ed). Covidien 46–53
MacDonald JD (2005) Learning to perform microvascular anastomosis. Skull base 15(3):229–240
Pruthi N, Gohil D, Somanna S (2018) Microvascular anastomosis using only 2-throw reef knots-: a technical note. Turk Neurosurg 29(6):961–963
Sudhir BJ, Murali SH, Jamaluddin MA et al (2021) Superficial temporal artery extended interposition graft to anterior cerebral artery bypass for the treatment of a large fusiform distal anterior cerebral artery aneurysm: 2-dimensional operative video. Oper Neurosurg. 21:E353
Thines L, Durand A, Penchet G et al (2014) Microsurgical neurovascular anastomosis: the example of superficial temporal artery to middle cerebral artery bypass. Technical principles. Neurochirurgie. 60:158–164
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(1) Conception or design of the work; (2) drafted the work or revised it critically for important intellectual content; and (3) approved the version to be published.
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Informed consent has been obtained from the patient whose surgical video excerpt has been included. There are no patient identifiers. Consent was obtained for publication.
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Summary (Key points)
• Microvascular suturing is a high-skill surgical manoeuvre.
• Efficient handling of microsutures requires constant practice using microscope in a laboratory.
• Resting of the ulnar surface of hands and forearms improves stability and reduces tremor.
• The performance of microvascular suturing through narrow surgical corridors at deep surgical sites is challenging.
• Disciplining the range of movements involved in knotting technique enhances the efficiency of the microvascular surgery.
• The Jai technique of knotting reduces the range of movement of the tips of the microinstruments.
• The Jai technique reduces the torque and traction at the surgical site, reducing the risk of the suture cutting through the blood vessel wall.
• Continuous drip irrigation of the surgical site with heparinised saline prevents the development of thrombosis.
• Saline irrigation breaks the surface tension and prevents entanglement of suture threads during knotting.
• Ambidexterity is advantageous in the placement of microvascular sutures.
This article is part of the Topical Collection on Vascular Neurosurgery - Other
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Sudhir, B.J. The Jai knot technique for deep microvascular surgery. Acta Neurochir 164, 1027–1029 (2022). https://doi.org/10.1007/s00701-022-05150-9
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DOI: https://doi.org/10.1007/s00701-022-05150-9