Document Detail

Assessing the adequacy of endoscopically tied knots: a functional approach.
MedLine Citation:
PMID:  15844018     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND STUDY AIMS: Endoscopic intracorporeal knots have potentially enormous applications in endoscopic surgery. We describe a method for testing the security of various types of endoscopically tied knots using a vessel perfusion manometer system. METHODS: A 4-cm segment of porcine splenic artery was placed on the mucosal surface of a pig stomach. The two ends of the vessel were brought out through the gastric wall and connected to a two-way manometer. One end was also joined to a pressure infusion bag. The stomach was mounted in an Erlangen training model. A long 3/0 nylon thread, previously introduced into the submucosal layer of the stomach and encircling the vessel, was brought out from the mouth. Three-throw square knots, Mayo knots, "surgeon's" knots and five-throw square knots were tied and pushed into place using a cap attached to a gastroscope. The pressure at the two ends of the artery was compared. If the pressure could be increased to over 200 mm Hg at one end without a change in the other, the knot was considered secure. RESULTS: Each type of knot was tested 12 times under endoscopic vision. The range for mean knotting time was 3.4 - 4.5 minutes. Five-throw knots took significantly longer to tie than three-throw knots (P < 0.005). There was one loose knot in each of the three-throw and Mayo groups, and three each in the "surgeon's" and five-throw groups (P > 0.05). CONCLUSIONS: This system is a reliable model for testing intracorporeal knots tied endoscopically. A three-half-hitches square knot with 3/0 nylon, tied using a flexible endoscope and knot-tightening cap, can withstand pressure up to 200 mm Hg.
B Hu; L C Sun; M Karmakar; P B Cotton; C J Gostout; R H Hawes; A N Kalloo; S V Kantsevoy; P J Pasricha; S C Chung
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Publication Detail:
Type:  In Vitro; Journal Article    
Journal Detail:
Title:  Endoscopy     Volume:  37     ISSN:  0013-726X     ISO Abbreviation:  Endoscopy     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-21     Completed Date:  2005-08-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  415-7     Citation Subset:  IM    
Endoscopy Center, Prince of Wales Hospital, The Chinese University of Hong Kong, China.
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MeSH Terms
Reproducibility of Results
Shear Strength
Splenic Artery / surgery*
Stomach / surgery*
Suture Techniques*
Tensile Strength

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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