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Intracorporeal knot-tying for the thoracoscopic surgeon: a novel and simplified technique.

ABSTRACT: Thoracoscopic surgery has usually been limited by 2-dimensional vision and the limited space between ribs--problems that have been only partially overcome by the use of robotics. One of the technical challenges of any minimally invasive surgical approach is tying an intracorporeal knot. For the thoracoscopic surgeon, we describe an easier technique of knot-tying that involves using a right-angled dissector. The technique enables ambidextrous performance and is particularly useful for ligating major pulmonary vessels that might be too small to be stapled or too confined for the admission and maneuvering of a stapling device. Rotating the thumb-dials accordingly enables one to vary the configuration of the knots to create slip or reef knots.The technique is easy to learn and does not require any complicated devices. It is easily adapted to create even more complex constructs, such as a double surgeon's knot. This technique has special advantages in areas of limited domain and in situations that require very narrow angles of instrument manipulation, particularly in thoracoscopic-assisted procedures.

SUBMITTER: Gopaldas RR

PROVIDER: S-EPMC2929853 | biostudies-literature | 2010

REPOSITORIES: biostudies-literature

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Intracorporeal knot-tying for the thoracoscopic surgeon: a novel and simplified technique.

Gopaldas Raja R RR Reul Ross M RM

Texas Heart Institute journal 20100101 4

Thoracoscopic surgery has usually been limited by 2-dimensional vision and the limited space between ribs--problems that have been only partially overcome by the use of robotics. One of the technical challenges of any minimally invasive surgical approach is tying an intracorporeal knot. For the thoracoscopic surgeon, we describe an easier technique of knot-tying that involves using a right-angled dissector. The technique enables ambidextrous performance and is particularly useful for ligating ma ...[more]

PMID: 20844616

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Project description:ObjectiveTying knots during suturing is one of the most challenging tasks in laparoscopic surgery. Therefore, measures aimed at ensuring both the ease and speed of knot tying not only benefit the surgeon but can also reduce operating time significantly. This study compared extracorporeal and intracorporeal knot tying techniques using a Szabo pelvic trainer model from the Gynaecological Endoscopic Surgical Education and Assessment program.DesignThe students tied intra- and extracorporeal knots using closed- and open-jaw knot pushers. Using an artificial tissue suturing pad in a certified Szabo pelvic trainer, students tied three knots using each technique according to block randomization. Task completion time, knot strength, knot-spread ability, and number of errors were recorded. The Wilcoxon test and mixed-effects models were used to analyze the results. After completing the exercises, participants answered a questionnaire concerning knot-tying techniques and their performance.SettingUniversity Hospital Basel, which provides tertiary-level clinical care.ParticipantsFifty-seven medical students with no experience in laparoscopy voluntarily signed up for this study.ResultsOpen and closed extracorporeal knot tying was significantly faster (p < 0.001, p < 0.001, respectively), more precise (p = 0.007, p = 0.003), and associated with reduced knot-spread ability (p < 0.001, p < 0.001) compared to intracorporeal knot tying. Open- and closed-jaw knot pushers were shown to be equal in terms of speed (p = 0.563), knot-spread ability (p = 0.49), and precision (p = 0.831). The study participants rated open (30 %) and closed (49 %) extracorporeal knot tying as more intuitive than intracorporeal (21 %) knot tying. Improved concentration was significantly correlated with tighter knots (p = 0.011).ConclusionsStudents achieved significantly better results using extracorporeal knot-tying techniques than intracorporeal ones, including greater speed, tighter knots, and optimized precision. These results suggest that beginners in the field of laparoscopy should be encouraged to practice extracorporeal knot-tying techniques.

Dataset Information

Intracorporeal knot-tying for the thoracoscopic surgeon: a novel and simplified technique.

Publications

Intracorporeal knot-tying for the thoracoscopic surgeon: a novel and simplified technique.

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