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Related Experiment Videos

Laparoscopic knot strength: a comparison with conventional knots

J H Dorsey1, H T Sharp, J D Chovan

  • 1Department of Gynecology, Greater Baltimore Medical Center, Maryland, USA.

Obstetrics and Gynecology
|October 1, 1995
PubMed
Summary

The study compared laparoscopic and conventional surgical knots, finding the Roeder knot significantly weaker. Stronger laparoscopic knots like the intracorporeal two-turn flat square knot are recommended for procedures with high suture tension.

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Area of Science:

  • Surgical innovation
  • Minimally invasive surgery
  • Surgical techniques

Background:

  • Laparoscopic surgery requires secure knot tying.
  • Traditional laparotomy knots may not translate effectively to laparoscopic techniques.
  • Assessing the tensile strength of various surgical knots is crucial for patient safety.

Purpose of the Study:

  • To compare the knot strength of commonly used laparoscopic techniques with traditional laparotomy knots.
  • To identify which knot geometries and suture materials yield the strongest results in laparoscopic surgery.
  • To provide evidence-based recommendations for knot selection in laparoscopic procedures.

Main Methods:

  • Tied three laparoscopic (Roeder, extracorporeal sliding square, intracorporeal two-turn flat square) and three conventional knots (flat square, surgeon's square, sliding square) using seven suture materials.

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  • Evaluated knot strength via tensiometer readings in a pelvic training model.
  • Utilized two-way analysis of variance and Turkey multiple-comparisons tests to analyze differences in knot strength (measured in newtons).

    • Main Results:

    • Significant differences in knot strength were observed based on knot geometry and suture material, with an interaction effect noted.
    • The laparoscopic Roeder knot was significantly weaker than all other tested knots.
    • The laparoscopic intracorporeal two-turn flat square knot demonstrated strength comparable to the strongest conventional knots.

    Conclusions:

    • The laparoscopic Roeder knot is not recommended for procedures involving significant suture line tension.
    • Laparoscopic knots such as the intracorporeal two-turn flat square knot and extracorporeal sliding square knot offer superior strength.
    • Surgeons should carefully select laparoscopic knots based on anticipated tension to ensure secure anastomoses.