Knot security in laparoscopic surgery

Amortegui, Jose D.; Restrepo, Hernán Valencia

doi:10.1007/s00464-002-8545-z

Cited by 21 publications

(8 citation statements)

References 9 publications

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“…Although fundoplication is considered by many as a straightforward procedure, the respective minimal invasive application requires the possession of advanced skills, like laparoscopic suturing. Secure laparoscopic knot tying is a difficultly acquired dexterity and it can make the difference between an uneventful postoperative period and an increased morbidity rate[42,43]. Therefore, in order to reduce operative time and complement the inexperience of younger surgeons in intracorporeal knotting, endoscopic suturing devices have been imported in clinical practice, with comparable results[44-46].…”

Section: Discussionmentioning

confidence: 99%

Single incision laparoscopic fundoplication: A systematic review of the literature

Perivoliotis

Sarakatsianou

Tepetes

et al. 2019

WJGS

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BACKGROUND Fundoplication, was first introduced as a surgical treatment method of gastroesophageal reflux disease. Consequently, several modifications of this method have been described, whereas laparoscopic fundoplication was recently introduced. Although single incision (SI) fundoplication was considered as an alternative to the conventional laparoscopic approach, several studies reported an increased operation duration, and high rates of multiport conversion and incisional hernia. AIM To provide a current overview of the technical variations and the postoperative outcomes of patients submitted to SI fundoplication. METHODS The present systematic review of the literature was designed and conducted on the basis of the PRISMA guidelines. A systematic screening of the electronic scholar databases (Medline, Scopus and Web of Science) was performed. RESULTS Literature search resulted in the identification of 19 studies. Overall, 266, 137 and 110 SI Nissen, Dor and Toupet fundoplications were reported, respectively. In the majority of the trials, standard laparoscopic instruments were used. The left liver lobe was displayed through the use of forceps, graspers, retractors, drains or even glue. Both intra-corporeal and extracorporeal suturing was described. Mean operative time was 136.3 min. Overall complication rate was 5.2% and the rate of incisional hernia was 0.9%. No mortality was reported. CONCLUSION Due to the methodological heterogeneity and the lack of high quality studies comparing multi to single access techniques and the several variations, we conclude that further well designed studies are necessary, in order to evaluate the role of SI fundoplication.

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Section: Discussionmentioning

confidence: 99%

Single incision laparoscopic fundoplication: A systematic review of the literature

Perivoliotis

Sarakatsianou

Tepetes

et al. 2019

WJGS

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“…Traditionally, this assessment has been made subjectively by surgical trainers. [ 6 7 ] However, such subjective assessment cannot precisely compare surgical skills since it often differs from trainer to trainer. Thus, there is now increased demand for objective assessment of LESS knot-tying performance and the safety of the knots.…”

Section: Discussionmentioning

confidence: 99%

Towards a better knot: Using mechanics methods to evaluate three knot-tying techniques in laparo-endoscopic single-site surgery

Jing-ci

2015

J Min Access Surg

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INTRODUCTION:Knot tying is difficult but important for laparo-endoscopic single-site surgery (LESS). There are several techniques for LESS knot-tying. However, objective assessment of these skills has not yet been established. The aim of this study was to assess three different knot-tying techniques in LESS using mechanical methods.MATERIALS AND METHODS:The subject tied 24 knots, eight knots with each of the three techniques in an inanimate box laparoscopic trainer while the movements of their instruments were evaluated using a LESS mechanical evaluation platform. The operations were assessed on the basis of the time, average load of the dominant hand. Then, forces caused the knots to rupture were measured using a material testing system and used to compare the knots's strength.RESULTS:The intracorporeal one-hand knot-tying technique presented significantly better time and average load scores than the extracorporeal knot-tying technique (P < 0.01), and the intracorporeal side winding technique was more time and average load consuming in comparison to other techniques during the performance of knot-tying (P < 0.01). The intracorporeal one-handed knot-tying knots can tolerate better distraction forces compared with the intracorporeal side winding knot-tying knots and the extracorporeal knot-tying knots (P < 0.05).CONCLUSIONS:The intracorporeal one-hand knot-tying technique and knots showed better results than the intracorporeal “side winding” technique and the extracorporeal knot-tying technique in terms of the time, average load taken and the force caused the knot to rupture.

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“…Palabras clave: apendicectomía laparoscópica; reúso; reprocesamiento; dispositivos médicos; desenlaces clínicos; Colombia. la intervención, y se sustentaron en la literatura disponible, la cual demuestra resultados clínicos equivalentes (complicaciones, reintervención y estancia hospitalaria) cuando se utilizan dispositivos de energía ultrasónica y bipolar avanzada versus la electrocoagulación monopolar o bilopar convencional, ligadura o clips de titanio en el mesenterio apendicular o cuando el muñón apendicular se cierra con diferentes recursos (nudos, suturas, clips) [21][22][23][24] .…”

Section: Introductionunclassified

Comparación de los desenlaces clínicos con cuatro técnicas de apendicetomía laparoscópica tras la implementación de políticas de reúso de dispositivos médicos

et al. 2021

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Introducción: Este estudio se comparan los desenlaces clínicos de cuatro técnicas de apendicectomía laparoscópica utilizadas en una institución colombiana tras la adopción políticas de reúso y reprocesamiento de dispositivos médicos para la Región de las Américas (2014).Materiales y métodos: Mediante el análisis de varianza de una vía (ANOVA) y la prueba de Kruskal Wallis, se compararon las tasas de infección de sitio operatorio (ISO), reoperación no planeada, readmisión y mortalidad (30 días postoperatorio) de las siguientes técnicas: Técnica-1: Ligadura del muñón apendicular con endonudo y disección del mesenterio apendicular con electrocoagulación bipolar convencional; Técnica-2: Clipaje del muñón con endoclip de polímero y disección del mesenterio con electrocoagulación bipolar convencional; Técnica-3: Clipaje del muñón con endoclip de polímero y disección del mesenterio con electrocoagulación monopolar; Técnica-4: Clipaje del muñón y disección roma y ligadura del mesenterio con endoclip de polímero. Resultados: Se incluyeron 551 pacientes. No se encontraron diferencias en los ANOVAs en cuanto a las características demográficas de los pacientes por cada técnica. Los desenlaces globales fueron: ISO (5.44%), reoperación no planeada (3.08%), readmisión (15,97%) y mortalidad (0.18%). Se encontraron diferencias significativas (p<0.05) en estos desenlaces explicados por mayores tasas de ISO y reoperación con la Técnica-1.Conclusiones: Los desenlaces globales de la apendicectomía laparoscópica tras la adopción de políticas de reúso de dispositivos médicos se encuentran dentro de los aceptados globalmente cuando se utilizan las Técnicas 2-3-4 en poblaciones equivalentes de pacientes con apendicitis aguda. En este contexto, nuestros resultados invitan a utilizar con precaución la Técnica-1.

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Knot security in laparoscopic surgery

Abstract: Laparoscopic knots are as secure as conventional knots. All knots must be made with six throws because security is maximized.

Cited by 21 publications

References 9 publications

Single incision laparoscopic fundoplication: A systematic review of the literature

Single incision laparoscopic fundoplication: A systematic review of the literature

Towards a better knot: Using mechanics methods to evaluate three knot-tying techniques in laparo-endoscopic single-site surgery

Comparación de los desenlaces clínicos con cuatro técnicas de apendicetomía laparoscópica tras la implementación de políticas de reúso de dispositivos médicos

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