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Knot integrity using different suture types and different knot-tying techniques for reconstructive pelvic floor

Omar F Dueñas-Garcia1, Gina M Sullivan2,3, Katherine Leung2,3

  • 1Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery Division, University of Massachusetts Medical School, Worcester, MA, USA. Omar.duenasgarcia@hsc.wvu.edu.

International Urogynecology Journal
|June 22, 2017
PubMed
Summary

Surgeons should consider suture characteristics beyond strength for pelvic reconstruction. Hand-tied knots demonstrated superior tensile strength compared to robotic methods, though both methods exceeded tissue failure points.

Keywords:
Hand tiedKnot integrityRobotically tiedSuture

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Area of Science:

  • Urology
  • Gynecology
  • Surgical Innovation

Background:

  • Pelvic reconstructive surgery utilizes diverse sutures and knot-tying techniques.
  • Suture and knot integrity are critical for successful surgical outcomes.

Purpose of the Study:

  • To test the hypothesis that knot-strength integrity is consistent across different knot types, suture materials, and tying methods.
  • To compare the tensile strength and elongation of hand-tied versus robotically-tied surgical knots.

Main Methods:

  • Six suture materials were used to tie flat square and slip knots robotically and by hand.
  • Knot integrity was assessed using an Instron 5544 machine, measuring force at failure/slippage and at 3-mm displacement.

Main Results:

  • Polyglyconate sutures yielded the highest tensile strength; OO-polydioxanone had the lowest.
  • Hand-tied knots exhibited greater tensile strength and elongation than robotically-tied knots.
  • Both slip knots and flat square knots showed similar integrity irrespective of the tying technique.

Conclusions:

  • Hand-tied knots offer greater tensile strength, but breaking strength for all knots required supraphysiological forces.
  • Suture choice should not be based solely on strength, as other characteristics and surgeon preference are important.
  • Current suture materials provide adequate strength for pelvic reconstructive procedures.