1
|
Wood C, Monnet E. Influence of a single locking throw on the in vitro holding security of five friction throws. Vet Surg 2024; 53:717-722. [PMID: 38402636 DOI: 10.1111/vsu.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To compare the in vitro security of four different friction throws (square, surgeon's, Miller's, and strangle), with and without a locking throw, and a slip knot, on a vascular ligation model. STUDY DESIGN Experimental study. SAMPLE POPULATION Nine groups with nine samples per group. METHODS Four throws (square, surgeon's, Miller's, and strangle), with and without a locking throw, and a square throw locked in slip knot fashion, were tested to measure leakage pressure. RESULTS The square and surgeon's throws leaked at a lower pressure than the Miller's and strangle throws (p < .0001). The leakage pressure was below physiologic arterial pressure for the square and the surgeon's throws. After the addition of a locking throw, the five knots leaked at a similar pressure (p = .5233) above physiologic arterial pressure. CONCLUSION Following the addition of a locking throw, all the constructs tested in this study leaked at a similar pressure. The leakage pressure for all knots exceeded physiologic arterial pressures. CLINICAL SIGNIFICANCE Any throw tested may be appropriate for secure vascular ligation if the initial throw is applied correctly.
Collapse
Affiliation(s)
- Chris Wood
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Eric Monnet
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| |
Collapse
|
2
|
Koninckx PR, Ussia A, Wattiez A, Kondo W, Romeo A. Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches. J Clin Med 2023; 12:6166. [PMID: 37834810 PMCID: PMC10573094 DOI: 10.3390/jcm12196166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing the active and passive ends has the same effect as changing the rotation. Loop security is the force to keep tissue together after a first half-knot or sliding half-hitches. With polyfilament sutures, H2, H3, SSs, and SSsSsSs have a loop security of 10, 18, 28, and 48 Newton (N), respectively. With monofilament sutures, they are only 7, 16, 18, and 25 N. Since many knots can reorganize, the definition of knot security as the force at which the knot opens or the suture breaks should be replaced by the clinically more relevant percentage of clinically dangerous and insecure knots. Secure knots with polyfilament sutures require a minimum of four or five throws, but the risk of destabilization is high. With monofilament sutures, only two symmetric+4 asymmetric blocking half-hitches are secure. In conclusion, in gynecology and in open and laparoscopic surgery, half-hitch sequences are recommended because they are mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilization.
Collapse
Affiliation(s)
- Philippe R. Koninckx
- Department of OBGYN, Faculty of Medicine, Katholieke University Leuven, 3000 Leuven, Belgium
- Department of OBGYN, Faculty of Medicine, University of Oxford, Oxford OX1 2JD, UK
- Department of OBGYN, Faculty of Medicine, University Cattolica, del Sacro Cuore, 00168 Rome, Italy
- Latifa Hospital, Dubai 9115, United Arab Emirates;
| | - Anastasia Ussia
- Department of OBGYN, Gemelli Hospitals, Università Cattolica, 00168 Rome, Italy;
| | - Arnaud Wattiez
- Latifa Hospital, Dubai 9115, United Arab Emirates;
- Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France
| | - William Kondo
- Centro Avançado de Cirurgia Ginecológica, Curitiba 81020-430, Brazil;
| | - Armando Romeo
- Project Leader Research Educational Center, University of Turin, 10124 Torino, Italy;
| |
Collapse
|
3
|
Belluzzi E, Santos MA, Jifcovici A, Redolfi G, Di Virgilio F, Deneuche A, Bongartz AL, Caraty JA. Comparison of the incidence of intra-operative haemorrhage from ovarian vessels during ovariectomy and ovariohysterectomy of dogs and cats performed by inexperienced surgeons using surgeon's and constrictor knots. N Z Vet J 2021; 70:88-94. [PMID: 34559597 DOI: 10.1080/00480169.2021.1985648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aims: To compare the incidence of intra-operative haemorrhage from ovarian vessels during ovariectomy (OV) and ovariohysterectomy (OVH) in dogs and cats performed by inexperienced surgeons using surgeon's and constrictor knots to ligate the ovarian pedicles.Methods: All client-owned female dogs (n = 51) and cats (n = 102) that presented for OV or OVH at two referral clinics in Belgium and France from January to June 2019 were included. Surgeries were performed by inexperienced surgeons under the supervision of diplomates or residents of the European College of Veterinary Surgeons. During routine and emergency OV or OVH one pedicle of each animal was ligated using a constrictor knot and the other with a surgeon's knot, the side assigned randomly. Time taken to perform each knot and the number of ligatures that resulted in intraoperative haemorrhage from the ovarian vessels were recorded. Body condition score (BCS) was recorded for 33 dogs and 22 cats.Results: The median time taken to perform constrictor knots in dogs (81 seconds), was longer than for surgeon's knots (69 seconds; p = 0.005). In cats, the median time taken to perform constrictor knots (109 seconds) was also longer than for surgeon's knots (90.5 seconds; p = 0.02).The number of dogs that had intra-operative haemorrhages from pedicles ligated with constrictor knots (2/102; 3.9%) was less than those ligated with surgeon's knots (10/102; 19.6%; p = 0.027). The median BCS of dogs that experienced haemorrhage (n = 8; median 5/9, min 3/9, max 7/9) was higher (p = 0.019) than that of dogs that did not experience haemorrhage (n = 25; median 4/9, min 3/9, max 8/9).There was no evidence (p = 1.0) of a difference in the proportion of cats that experienced intra-operative haemorrhage from pedicles ligated with constrictor knots (3/44; 6.8%) and those ligated with surgeon's knots (2/44; 4.5%). Two-thirds of the haemorrhages with constrictor knots were caused by pedicle rupture during tightening.Conclusions: The rate of intraoperative haemorrhage from the ovarian pedicle was lower when a constrictor knot was used compared to a surgeon's knot in dogs but not in cats. While the constrictor knot was more time consuming to tie this is not likely to have a clinical impact. Use of this knot by inexperienced surgeons in dogs may help to reduce the risk of intraoperative haemorrhage during OVH/OV.
Collapse
Affiliation(s)
- E Belluzzi
- Department of Small Animal Surgery, VET TEAM, Liège, Belgium
| | - M A Santos
- Department of Small Animal Surgery, VET 24, Marcq en Baroeul, France
| | - A Jifcovici
- Department of Small Animal Surgery, VET TEAM, Liège, Belgium
| | - G Redolfi
- Department of Small Animal Surgery, VET 24, Marcq en Baroeul, France
| | - F Di Virgilio
- Department of Small Animal Surgery, VET 24, Marcq en Baroeul, France
| | - A Deneuche
- Department of Small Animal Surgery, VET 24, Marcq en Baroeul, France
| | - A L Bongartz
- Department of Small Animal Surgery, VET TEAM, Liège, Belgium
| | - J A Caraty
- Department of Small Animal Surgery, VET TEAM, Liège, Belgium
| |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
- Andrea K Erickson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - W Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
5
|
Okasha M, Dobson GM, Tsonis I, Hussain M, Ross N. Shunt disconnection is less likely using a surgeon's knot compared with a surgical constrictor knot. Br J Neurosurg 2020; 35:216-219. [PMID: 32608285 DOI: 10.1080/02688697.2020.1782834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Ventriculo-peritoneal shunt malfunction is a common neurosurgical presentation, which may occur as a result of shunt disconnection at the level of the valve. Previous studies assessing ligatures have suggested that the constrictor knot is stronger in securing a ligature compared to the surgeon's knot. Our study compared the ability of each knot to secure shunt tubing to the valve. METHODS A medtronic shunt valve was secured to a peritoneal catheter using the surgeon's knot versus constrictor's knot. The weight and subsequent force (N) required to pull off the shunt tubing at the knot site were recorded. RESULTS The mean pull-off force was 11.7 N for the surgeon knot, and 8.9 N for the constrictor knot. There was significant difference in favour for the surgeon's knot compared to the constrictor knot. CONCLUSIONS The surgeon's knot is significantly stronger than the constrictor knot for securing a peritoneal catheter to a CSF shunt valve.
Collapse
Affiliation(s)
- Mohamed Okasha
- Neurosurgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Gareth M Dobson
- Neurosurgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ioannis Tsonis
- Neurosurgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Mohammed Hussain
- Neurosurgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Nicholas Ross
- Neurosurgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| |
Collapse
|
6
|
Gandini M, Comino F, Caramello V, Giusto G. Evaluation of three ligatures in simulated equine open castration. Vet Surg 2020; 49:704-709. [PMID: 32003034 DOI: 10.1111/vsu.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare three surgical knots for preventing leakage from the vascular bundle during ligation in simulated equine open castrations. STUDY DESIGN Randomized, case-control, in vitro study. SAMPLE POPULATION Testes (N = 60) collected from 30 horses. METHODS Testes were collected from 30 horses and randomly assigned to one of three groups: group G (friction, giant knot), group T (modified transfixing knot), or group S (sliding, strangle knot; n = 20/group). The assigned knot was used to ligate the vascular bundle during open castration. The length of suture material used and the leak pressure of the testicular artery were measured and compared between groups. RESULTS Strangle knots consistently leaked at higher pressures (median, 735.5 mm Hg; interquartile range [IQR], 735.5-735.5) compared with giant (median, 441.3 mm Hg; IQR, 367.8-643.6) and transfixing (median, 419.2 mm Hg; IQR, 323.6-643.6; P < .0001) knots. Both the strangle (median, 5 cm; IQR, 4.5-5.5) and giant (median, 6 cm; IQR, 5.35-6.075) knots required less suture material compared with the transfixing (median, 9.2 cm; IQR, 8.425-10.38; P < .0001) knot. CONCLUSION The three surgical knots tested withstood pressure well above physiological levels in simulated open castrations. The strangle knot withstood higher pressure and required similar (giant) or less (transfixing) suture material than the other two knots. CLINICAL SIGNIFICANCE This study provides evidence to support the use of a strangle knot to ligate the vascular bundle during simulated open castrations in horses.
Collapse
Affiliation(s)
- Marco Gandini
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Francesco Comino
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | | | - Gessica Giusto
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| |
Collapse
|