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Tieken KR, Kelly G, Maxwell J, Visenio MR, Reynolds J, Fingeret AL. Feedback Versus Compliments Versus Both in Suturing and Knot Tying Simulation: A Randomized Controlled Trial. J Surg Res 2024; 294:99-105. [PMID: 37866070 DOI: 10.1016/j.jss.2023.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Suturing is an expected skill for students graduating from health professions programs. Previous studies investigated student experience with teaching sessions utilizing constructive feedback versus compliments but did not investigate the combination of both. METHODS In this parallel, randomized controlled trial, participants were divided into three groups: feedback (F), compliments (C), or feedback and compliments (FC). Participants received standardized instruction on simple interrupted suturing and two-handed knot-tying, and were videotaped performing this skill before and after the intervention. Performance was evaluated using a validated Objective Structured Assessment of Technical Skills (OSATS) instrument. Participants completed a preintervention and postintervention survey rating their task enjoyment and self-assessment of performance. Analysis was performed to determine differences between and within the groups using Kruskal-Wallis, Wilcoxon rank-sum, and Mann-Whitney U tests. RESULTS A total of 31 students participated: 11 in C, 10 in F, and 10 in FC. The groups had similar preintervention OSATS scores. The F and FC groups demonstrated significant improvement in OSATS score after intervention, group C was not significantly different: F median of 11.25-19.75 points (P = 0.002); FC median of 11.75-21 points (P = 0.002); C median of 13-14 points (P = 0.2266). Between the groups FC and F both had significant performance improvement compared with C (P < 0.001 and P = 0.001 respectively). The FC group had a significantly higher rating of their enjoyment of the task on the postintervention survey compared with both the C and F groups with a median rating of 10 compared with 8 and 8 (P = 0.0052 and P = 0.0126, respectively). CONCLUSIONS The combination of feedback and compliments was associated with improvement in performance on suturing and knot-tying similar to the feedback-only group. The FC group rated a higher level of enjoyment of the activity compared to feedback or compliments alone.
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Affiliation(s)
- Kelsey R Tieken
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Grace Kelly
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jessica Maxwell
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michael R Visenio
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jannelle Reynolds
- Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Abbey L Fingeret
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
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Pourak K, Zugris N, Palmon I, Monovoukas D, Waits S. Nodo-Tie: an innovative, 3-D printed simulator for surgical knot-tying skills development. Surg Open Sci 2023; 16:221-225. [PMID: 38035223 PMCID: PMC10687015 DOI: 10.1016/j.sopen.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Clinical simulators are an important resource for medical students seeking to improve their fundamental surgical skills. Three-dimensional (3-D) printing offers an innovative method to create simulators due to its low production costs and reliable printing fidelity. We aimed to validate a 3-D printed knot-tying simulator named Nodo-Tie. Methods We designed a 3-D printed knot-tying simulator integrated with a series of knot-tying challenges and a designated video curriculum made accessible via a quick-response (QR) code. The Nodo-Tie, which costs less than $1 to print and assemble, was distributed to second-year medical students starting their surgical clerkship. Participants were asked to complete a survey gauging the simulator's usability and educational utility. The time between simulator distribution and survey completion was eight weeks. Results Students perceived the Nodo-Tie as easy-to-use (4.6 ± 0.8) and agreed it increased both their motor skills (4.5 ± 0.9) and confidence (4.5 ± 0.8) for tying surgical knots in the clinical setting. Many students agreed the Nodo-Tie provided a stable, durable surface for knot-tying practice (83.7%, n = 41) and that they would continue to use it beyond their participation in the study period (91.7%, n = 44). Discussion Medical students found this interactive, 3-D printed knot-tying simulator to be an effective tool to use for self-directed development of their knot-tying skills. Given the Nodo-Tie's low cost, students were able to keep the Nodo-Tie for use beyond the study period. This increases the opportunity for students to engage in the longitudinal practice necessary to master knot-tying as they progress through their medical education. Key messages Clinical simulators provide proactive learners with reliable, stress-free environments to engage in self-directed surgical skills development. The Nodo-Tie, a 3-D printed simulator, serves as a cost-effective, interactive tool for medical students to develop their knot-tying abilities beyond the clinical setting.
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Affiliation(s)
- Kian Pourak
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Nicholas Zugris
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Itai Palmon
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | | | - Seth Waits
- Department of Surgery, Michigan Medicine, Section of Transplant Surgery, Ann Arbor, MI 48109, USA
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Kocazeybek E, Meric E, Ersin M, Ekinci M, Kizilkurt T, Sahinkaya T, Polat G. Clinical outcomes of three different techniques using adjustable-loop fixation in arthroscopic single-bundle anterior cruciate ligament reconstruction: A prospective randomized clinical trial. Knee 2023; 43:208-216. [PMID: 37467701 DOI: 10.1016/j.knee.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/14/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Adjustable femoral suspensory fixation for anterior cruciate ligament reconstruction (ACLR) become popular in recent years. The purpose of this study is to evaluate and compare the clinical outcomes of three different techniques using an adjustable-loop fixation in ACRL. METHODS This study included 38 patients who underwent ACLR using the adjustable-loop device for femoral fixation between January 2018 and November 2021. All the participants were randomly assigned to a standard (group 1), retensioning (group 2), retensioning and knot tying (group 3). Clinical outcome parametres included Tegner - Lysholm Score, IKDC score, KT-1000 displacement and isokinetic muscle function tests. RESULTS Overall, 38 patients (group 1: n = 13 [mean ± SD age, 30.1 ± 9.40 years]; group 2: n = 12 [mean ± SD age, 24.5 ± 7.79 years]; group 3 = 13 [mean ± SD age, 27.8 ± 6.59 years]) were included in the final analysis. The follow-up period was 9.7 ± 1.2; 9.5 ± 1.7 and 10 ± 1.5 months for groups 1, 2 and 3 respectively. From preoperatively to postoperatively, the mean Tegner-Lysholm scores improved significantly in all three groups (group 1: from 63.5 to 95.6; group 2: from 61.58 to 98.5; group 3: from 66.6 to 95.9, P < 0.0001 for all), as did the mean IKDC score (group 1: 53.9-88.8; group 2: 61.3-94.9; group 3: 60.7-94.6 (P < 0.0001 for all). CONCLUSION The retensioning with or without knot-tying method is believed to increase stability in graft fixation. However, there were no significant differences in clinical outcomes in each technique.
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Affiliation(s)
- Emre Kocazeybek
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey.
| | - Emre Meric
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Mehmet Ersin
- Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Ekinci
- Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Taha Kizilkurt
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Turker Sahinkaya
- Istanbul Faculty of Medicine, Department Sports Medicine, İstanbul, Turkey
| | - Gokhan Polat
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
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Harato K, Yagi M, Kaneda K, Iwama Y, Masuda A, Kaneko Y, Oya A, Matsumura N, Suzuki T, Nakayama R, Kobayashi S. Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees. BMC Surg 2021; 21:75. [PMID: 33549063 PMCID: PMC7866735 DOI: 10.1186/s12893-021-01079-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons' manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees. METHODS A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees. Although four open conventional knots with four throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with two cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively. RESULTS Twenty-four instructors (PGY6-PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7 N) than in instructors (49.9 ± 34.4 N, P = 0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P < 0.001). Knot slippage (31.8 ± 17.7 N) was significantly worse than suture rupture (89.9 ± 22.2 N, P < 0.001) in tensile strength. CONCLUSIONS Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.
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Affiliation(s)
- Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan. .,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan.
| | - Kazuya Kaneda
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Yu Iwama
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Akihiko Masuda
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Yosuke Kaneko
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Akihito Oya
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Keio Orthopedic Advancing Squad for the Interactive Study (OASIS), Keio University School of Medicine, Tokyo, Japan
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Abstract
Simulation and dedicated practice outside the operating room can improve surgical technique and enhance intraoperative learning and performance. We designed a "do-it-yourself" simulator for use at home made from inexpensive, readily accessible materials that faithfully recreates multiple operative scenarios in cardiac surgery. This video tutorial demonstrates how to build our modular cardiac surgery simulator and to practice drills using our Basic Surgical Skills Module, which helps hone basic linear suturing, needle angles, and knot tying.
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Affiliation(s)
- John Kelly
- Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America
| | - Amit Iyengar
- Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America
| | - William Patrick
- Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America
| | - Mark Helmers
- Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America
| | - Benjamin Smood
- Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America
| | - Jason Han
- Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America
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Xu PP, Chang XP, Tang ST, Li S, Cao GQ, Zhang X, Chi SQ, Fang MJ, Yang DH, Li XY. Robot-assisted thoracoscopic plication for diaphragmatic eventration. J Pediatr Surg 2020; 55:2787-2790. [PMID: 32711940 DOI: 10.1016/j.jpedsurg.2020.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Though conventional thoracoscopic plication is a favorable option of diaphragmatic eventration (DE), ribs limited the movement of trocars, making it difficult to suturing, knot-tying and time-consuming. The purpose of this study was to evaluate delicate surgical maneuvers and suturing time for the management of DE in robot-assisted thoracoscopic plication (RATP). METHODS From January 2015 to November 2019, 20 patients (14 males; mean age: 10.5 ± 5.2 months; mean weight: 8.6 ± 4.5 kg) who underwent diaphragmatic plication for DE were reviewed at our institution. There were 13 patients with congenital diaphragmatic eventration and 7 patients with acquired diaphragm eventration after congenital heart surgery. RATP was performed on 9 patients (3 on the left and 6 on the right), and conventional thoracoscopic plication (CTP) was applied to 11 patients (5 on the left and 6 on the right). Demographics, the suturing time and complications were respectively evaluated. RESULTS There was no difference between 2 groups with respect to gender, age at surgery and weight (p > 0.05). No conversion to thoracotomy was needed. The suturing time in RATP group was shorter than CTP group (27.7 ± 3.4 min vs 48.1 ± 4.2 min, p < 0.001). One patient (9.09%) experienced recurrence in CTP group and none was found in RATP group. CONCLUSIONS Diaphragmatic plication with robot-assisted thoracoscopy or conventional thoracoscopy in DE has minimally invasive and good effect on children. RATP overcome the intercostal limitations to complete delicate suturing and free knot-tying, and has better ergonomics. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Pei-Pei Xu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiao-Pan Chang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guo-Qing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shui-Qing Chi
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Mi-Jing Fang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - De-Hua Yang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiang-Yang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Hsu JL, Korndorffer JR, Brown KM. Design of vessel ligation simulator for deliberate practice. J Surg Res 2015; 197:231-5. [PMID: 25840488 DOI: 10.1016/j.jss.2015.02.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/16/2015] [Accepted: 02/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical residents develop technical skills at variable rates, often based on random chance of cases encountered. One such skill is tying secure knots without exerting excessive force. This study describes the design of a simulator using a force sensor to measure instantaneous forces exerted on a blood vessel analog during vessel ligation and the development of expert-derived performance goals. MATERIALS AND METHODS Vessel ligations were performed on Silastic tubing at an offset from a Vernier Force Sensor. Nine experts (surgical faculty and senior residents) and 10 novices (junior residents) were recruited to each perform 10 vessel ligations (two square knots each) with two-handed and one-handed techniques. Internal consistency for the series of vessel ligations was tested with Cronbach alpha. Maximum forces exerted by novices and experts were compared using Student t-test. RESULTS Internal consistency across the 10 ligations on the simulator was excellent (Cronbach alpha = 0.91). The expert group on average exerted a significantly lower maximum force when compared with novices while performing two-handed (0.76 ± 0.39 N versus 1.12 ± 0.49 N, P < 0.01) and one-handed (0.84 ± 0.32 N versus 1.36 ± 0.44 N, P < 0.01) vessel ligations. CONCLUSIONS Although the expert group performed vessel ligations with significantly lower peak force than the novice group, there were novices who performed at the expert level. This is consistent with the conceptual framework of milestones and suggests that the skill of gentle knot-tying can be measured and develops at different chronologic levels of training in different individuals. This simulator can be used as part of a deliberate practice curriculum with instantaneous visual feedback.
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Affiliation(s)
- Justin L Hsu
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - James R Korndorffer
- Department of Surgery, Tulane University School of Medicine, New Orleans, Los Angeles
| | - Kimberly M Brown
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
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Gopaldas RR, Reul RM. Intracorporeal knot-tying for the thoracoscopic surgeon: a novel and simplified technique. Tex Heart Inst J 2010; 37:435-438. [PMID: 20844616 PMCID: PMC2929853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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.
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Affiliation(s)
- Raja R Gopaldas
- Department of Cardiovascular Surgery, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, Texas 77030, USA
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