An evaluation of knot integrity when tied robotically and conventionally

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Biomaterials Science

Background:

• Sacrocolpopexy is a surgical procedure to treat pelvic organ prolapse.
• Suture knot integrity is critical for the success of sacrocolpopexy.
• Robotic surgery is increasingly used, necessitating evaluation of its impact on surgical techniques like knot tying.

Purpose of the Study:

• To compare the knot integrity of commonly used sutures in sacrocolpopexy when tied conventionally versus robotically.
• To identify potential weaknesses in specific suture materials or tying methods.

Main Methods:

• Three suture materials (polyglactin 910, polypropylene, polyester) were evaluated.
• Knots were tied using both conventional (hand) and robotic techniques.
• Tensile force was applied to determine the force required for knot untying or suture breakage.

Main Results:

• Robotically tied polyglactin 910 knots demonstrated significantly lower integrity, untying at a mean force of 47.7 +/- 18.8 Newtons.
• These knots were weaker than all other tested robotic and conventional knots (P < .05).
• A significant interaction between tying modality and suture material (P < .001) indicated that material performance differed based on the tying method.

Conclusions:

• Knot failure rates in sacrocolpopexy are influenced by both the suture material and the tying technique (conventional vs. robotic).
• Specific suture materials, like polyglactin 910, may be more susceptible to failure when tied robotically.
• Careful consideration of suture material and tying method is essential for ensuring robust knot security in robotic sacrocolpopexy.