A technique to secure a knot in a confined space

Al-Benna, Sammy; Banieghbal, Behrouz

doi:10.1308/rcsann.2020.0204

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…(Figure 2). Although forces were not measured, the unstable granny knot (H1H1a) and H2H1a can be used to secure veins [28] or for wound closure [21].…”

Section: Loop Securitymentioning

confidence: 99%

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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

Koninckx,

Ussia,

Wattiez

et al. 2023

JCM

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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.

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“…(Figure 2). Although forces were not measured, the unstable granny knot (H1H1a) and H2H1a can be used to secure veins [28] or for wound closure [21].…”

Section: Loop Securitymentioning

confidence: 99%

“…(Figure 2). A forces were not measured, the unstable granny knot (H1H1a) and H2H1a can be secure veins [28] or for wound closure [21]. For monofilament sutures, such as polyglecaprone 2.0 (Monocryl), the loop is lower than for polyfilament sutures.…”

Section: Loop Securitymentioning

confidence: 99%

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

Koninckx,

Ussia,

Wattiez

et al. 2023

JCM

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Suturing in Gynaecological Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilisation of Half-Knots or Half-Hitches

Koninckx,

Ussia,

Wattiez

et al. 2023

Preprint

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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 sliding (s) or blocking (b). Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing active and passive ends has the same effect as changing 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 25N. Since many knots can reorganise, 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 4 or 5 throws, but the risk of destabilisation is high. With monofilament sutures, only 2 symmetric+4 asymmetric blocking half-hitches are secure. In conclusion, half-hitch sequences are recommended since mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilisation.

show abstract

A technique to secure a knot in a confined space

Cited by 2 publications

References 5 publications

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

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

Suturing in Gynaecological Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilisation of Half-Knots or Half-Hitches

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