دورية أكاديمية
Which Knots Are Recommended in Laparoscopic Surgery and How to Avoid Insecure Knots.
| العنوان: | Which Knots Are Recommended in Laparoscopic Surgery and How to Avoid Insecure Knots. |
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| المؤلفون: | Romeo A; Departments of Gynecology and Obstetrics (Dr. Romeo), University of Torino, Torino, Italy; Project Leader REC Research Educational Centre Department of Gynecology and Obstetrics University of Torino (Dr. Romeo), Torino, Italy., Fernandes LF; University of São Paulo (Dr. Fernandes), Sao Paulo, Brazil., Cervantes GV; Santa Casa University of São Paulo Hospital (Dr. Cervantes), Sao Paulo, Brazil., Botchorishvili R; Department of Gynecologic Surgery, CHU Estaing and International Center for Endoscopic Surgery (Dr. Botchorishvili), Clermont-Ferrand, France., Benedetto C; Departments of Gynecology and Surgical Sciences (Dr. Benedetto), University of Torino, Italy., Adamyan L; Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov Research Centre for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation and Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry (Dr. Adamyan), Moscow, Russia., Ussia A; Gruppo Italo Belga, Villa del Rosario and Gemelli Hospitals Università Cattolica (Dr. Ussia), Rome, Italy., Wattiez A; University of Strasbourg, Alsace, France and Latifa Hospital (Dr. Wattiez), Dubai, United Arab Emirates., Kondo W; Department of Gynecology (Dr. Kondo), Sugisawa Hospital, Curitiba, Paraná, Brazil., Koninckx PR; Department of Obstetrics and Gynecology (Dr. Koninckx), Catholic University Leuven, University Hospital, Gasthuisberg, Leuven, Belgium. Electronic address: pkoninckx@gmail.com. |
| المصدر: | Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2020 Sep - Oct; Vol. 27 (6), pp. 1395-1404. Date of Electronic Publication: 2019 Sep 20. |
| نوع المنشور: | Journal Article; Technical Report |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 101235322 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1553-4669 (Electronic) Linking ISSN: 15534650 NLM ISO Abbreviation: J Minim Invasive Gynecol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Philadelphia, PA : Elsevier, c2005- |
| مواضيع طبية MeSH: | Laparoscopy/*standards , Surgical Wound Dehiscence/*prevention & control , Suture Techniques/*standards , Sutures/*standards, Humans ; Laparoscopy/adverse effects ; Laparoscopy/education ; Laparoscopy/methods ; Patient Safety ; Postoperative Complications/prevention & control ; Practice Guidelines as Topic ; Surgeons/education ; Suture Techniques/adverse effects ; Suture Techniques/education |
| مستخلص: | Study Objective: To investigate why security of identical knot sequences is variable and how to avoid occasionally insecure knots. Design: A factorial design was used to assess factors affecting the security of half knot (H) and half-hitch (S) knot combinations. The effect of tying forces and the risk factors to transform H knots into S knots were investigated. The risk factors evaluated were as follows: starting with an H1 or H2 instead of an H3 knot, inexperience, short sutures, and monomanual knot tying. Security of transformed knots, S2S1 and S2S2 knots, and their recuperation with 2 additional half hitches, SSb or SbSb, were evaluated. Setting: Training center for laparoscopic suturing. Patients: Not applicable. Interventions: Security of knots was evaluated in vitro. Measurements and Main Results: The forces that caused knot combinations to open before breaking of the suture were used to calculate the risk of opening with low forces. Tying more strongly increased the security of half knots (H2H1sH1s) (p <.02) and half hitches (p <.001). The forces needed to transform an H3 into an S3 are higher than those for an H2 (p <.001), and the risk increases when the surgeon is inexperienced (p <.001), when sutures are short (p <.001), and when monomanual knot tying (p <.001) is used. Inadvertently made S2S1 and S2S2 knots are dangerous, with the exception of the symmetric S2S2, which is stable. Unstable knots such as S2S1a and S2S2a knot combinations improve with 2 additional blocking half hitches (SbSb), but S2S2aSbSb remains occasionally insecure. Conclusion: To reduce the risk of accidentally transforming a first H into an S knot, it is recommended to start with an H3, tie with force, avoid short sutures, and use bimanual suturing. This permits the recommendation to use preferentially H3H2 knots or 5 half hitches (SSSbSbSb). When in doubt, half knot combinations should be secured with at least 2 blocking half hitches. (Copyright © 2019 AAGL. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Knot security; Knot tying; Knots; Surgery; Suturing |
| تواريخ الأحداث: | Date Created: 20190924 Date Completed: 20210201 Latest Revision: 20210201 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1016/j.jmig.2019.09.782 |
| PMID: | 31546065 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1553-4669 |
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| DOI: | 10.1016/j.jmig.2019.09.782 |