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A comparison of knot security of commonly used hand-tied laparoscopic slipknots
Donna L Shettko1, David D Frisbie, Dean A Hendrickson
1Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, USA. dshetko@aol.com
Objective:
To compare the peak force required for failure of hand-tied laparoscopic slipknot ligatures.
Study Design:
In vitro mechanical evaluation of suture material/knot combinations.
Sample Population:
Four hand-tied laparoscopic slipknots were studied. Three suture materials and 2 suture sizes were evaluated. Twenty samples of each group were tested, for a total of 400 samples.
Methods:
The 4S modified Roeder, modified Roeder, and Weston and Brooks laparoscopic slipknots using 0 polyglyconate, 0 polyglycolic acid, 1 polyglyconate, and 1 polydioxanone (PDS) were tested. A vertical distracting force (5 mm/s) was applied until failure. Mean peak force to failure was obtained for each suture material, size, and knot combination.
Results:
Mean (+/-SEM) peak force to failure of hand-tied ligatures ranged from 156.8+/-9.1 N to 4.8+/-.4 N. The 4S-modified Roeder had the highest mean peak force to failure. Ligatures tied with polyglyconate and size 1 suture had the highest mean peak force to failure.
Conclusions:
The 4S-modified Roeder was significantly and consistently stronger than the other slipknots. Polyglyconate was superior to other suture materials. The 1 polyglyconate had the highest mean peak force to failure followed by 0 polyglyconate that exceeded the 1PDS.
Clinical Relevance:
The 4S-modified Roeder slipknot using 1 polyglyconate has the greatest breaking strength of sutures tested and should be considered when performing laparoscopic ligatures.