Forough Radfar¹*, Mohammad Zeinalddin² and Moein Zeinalddin³

¹Senior Consultant and Head of Department of Obstetrics and Gynecology, Diwan of Royal court Health Complex, Muscat, Oman
²Senior Lecturer and Course Coordinator, Oman Dental College, Muscat, Oman
³Oman Medical College, Muscat, Oman

*Corresponding Author: Forough Radfar, Senior Consultant and Head of Department of Obstetrics and Gynecology, Diwan of Royal Court Health Complex, Muscat, Oman.

Received: April 19, 2021; Published: : May 25, 2021

Citation: Forough Radfar., et al. “An Innovative Technique of Laparoscopic Knot Tying: A Qualitative Explanatory Research". Acta Scientific Medical Sciences 5.6 (2021): 129-139.

Abstract

Objective: To introduce an innovative laparoscopic knot tying technique using loop knot guide or needle knot guide designed for extracorporeal knot tying and using needle holder for intracorporeal knot tying to be ergonomically more suitable than traditional knot tying techniques for minimally invasive surgery.

Design: A qualitative, explanatory research design is used to describe a new technique of laparoscopic knot tying using our self-designed loop and needle knot guide devices for extracorporeal knot tying and using needle holder for intracorporeal knot tying.

Setting: Laparoscopic simulator trainer laboratory was used to examine different techniques of knot tying. No human or animal subjects were used.

Method: Various knot tying techniques (laparoscopic knots, surgical knots, knitting knots, fishing knots, and sailor’s knots) were reviewed online using internet search engines, books and practical observation. The instruments which were used to assist in achieving knot tying with correct configuration, appropriate shaping and maximum security were studied.

We designed the new techniques of laparoscopic knot tying using our self-designed loop and needle knot guide and needle holder to cast the capsized form of the desired laparoscopic knot extracorporeally by working end of suture over them and pulling the standing end or needle end through it to form the sliding knot.

Technique: Intracorporeal knot tying: Working end of suture is casted in form of capsized configuration of the slip knot, on the shaft of needle holder before it is introduced into the body for intracorporeal suturing. Slip knot is formed by pulling the needle end of suture through the casted working end.

Extracorporeal Knot tying: Working end of suture is casted in form of capsized configuration of the slip knot, on the shaft of an appropriately sized self-designed loop or needle knot guide and the standing end is pulled through the casted working end of suture by using loop or needle knot guide, to form a slip knot extracorporeally. The knot is slid on standing end by knot pusher to the site where knot is to be applied.

Result: Using the innovative laparoscopic technique we achieved:

• Accurate knot reproducibility, security and stability.
• Least amount of suture material is used in forming the knot so it decreases risk of foreign body reaction in patient’s tissues.
• Taking into consideration the ergonomics of laparoscopic surgery, this technique reduces fatiguability and trauma to surgeon.
• It also facilitates reduction of the angle between the working instruments while knot tying, so ports could be placed closer to each other, even single port laparoscopic knot tying is possible with this technique.
• It reduces instrument movements intracorporeally while applying the knot hence it decreases risk of trauma to patient.

Conclusion: Our innovative laparoscopic knot tying technique is an ergonomically suitable and simplified technique for laparoscopic knot tying, reduces related trauma to surgeon and reduces iatrogenic effects to patients.

Keywords: Minimally Invasive Surgery; Minimal Access Surgery; Laparoscopy; Extracorporeal; Intracorporeal; Knot Tying; Tissue Approximation

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Copyright: © 2021 Forough Radfar., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.