Erickson AK, Fox-Alvarez WA, Regier PJ, Case JB. In vitro holding strength of the laparoscopic Miller's knot compared with open Miller's knot, open surgeon's throw, and laparoscopic surgeon's throw in a vascular pedicle model.
Vet Surg 2020;
49:1563-1570. [PMID:
32645239 DOI:
10.1111/vsu.13479]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/12/2020] [Accepted: 05/30/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE
To compare in vitro knot holding strength of the laparoscopic Miller's knot (LMK), open Miller's knot (MK), open surgeon's throw (Sx), and laparoscopic surgeon's throw (LSx) in a vascular pedicle model when used as the first throw for vascular ligation.
STUDY DESIGN
Experimental study.
SAMPLE POPULATION
Ten constructs each of the Miller's knot and surgeon's throw performed openly and laparoscopically with 2-0 polyglyconate suture.
METHODS
Knot holding strengths of the LMK, MK, LSx, and Sx knots were evaluated on balloon dilation catheters used as vascular pedicle models. Laparoscopic knots were tied in a laparoscopic box trainer. Knot constructs were pressure tested to failure. Results were compared by Kruskal-Wallis and Steel-Dwass comparisons.
RESULTS
Both MK and LMK had mean leakage pressures above 300 mm Hg. The MK leaked at higher pressure than all other knots, including the LMK (P < .001). The LMK leaked at greater pressures compared with the Sx and the LSx (P < .001). No difference was detected between leaking pressures of the Sx and the LSx (P = .226), with both leaking at pressures below 40 mm Hg.
CONCLUSION
The LMK created a more secure first throw compared with the Sx and leaked at supraphysiologic pressures.
CLINICAL SIGNIFICANCE
The LMK has excellent knot holding strength on a vascular pedicle model and may be further evaluated for clinical application.
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