How reliable is intracorporeal laparoscopic knot tying?

Area of Science:

• Surgical techniques
• Biomaterials science
• Surgical knotting

Background:

• Assessing the reliability of laparoscopic surgical knots compared to traditional open surgery knots.
• Investigating potential differences in knot security based on tying method and suture material.

Purpose of the Study:

• To compare the reliability of laparoscopic surgical knots with hand-tied and instrument-tied knots.
• To evaluate the impact of different suture materials on knot security in laparoscopic surgery.

Main Methods:

• Standardized laparoscopic knot tying (hand, instrument, laparoscopic) using three suture materials in a simulator.
• Measurement of knot tension at tying and 5 minutes post-tying.
• Materials testing machine analysis of suture breakage force, extension, and breaking points.

Main Results:

• No significant differences in suture tension were observed at 5 minutes across materials or tying methods.
• Three of 12 laparoscopic knots, all monofilament sutures, failed during strain testing.
• Mean extension to breakage for 33 sutures was 29.71 mm with a force of 16.09 N.

Conclusions:

• Suture tension remains stable for 5 minutes regardless of material or knot-tying method.
• Monofilament sutures tied laparoscopically demonstrated lower reliability, with a notable failure rate under strain.
• Findings suggest careful consideration of suture material choice for laparoscopic procedures.