Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd, Banqiao, New Taipei, 220, Taiwan.
Surg Endosc. 2012 Mar;26(3):872-6. doi: 10.1007/s00464-011-1971-z. Epub 2011 Oct 13.
Laparoscopic intracorporeal knot tying has traditionally been considered the most difficult skill in laparoscopic surgery. We developed a novel device for assisting laparoscopic intracorporeal knotting that transforms a pre-tied slip knot into a secure double sheet bend. The aim of this study is to check the feasibility of using this novel device to assist in performing laparoscopic knot tying.
We used a laparoscopic trainer with a piece of plastic artificial skin as an experimental model. Twenty laparoscopic device-assisted double sheet bends (experimental group) and 20 traditional laparoscopic two-turn flat square knots (control group) were performed in random order. After cutting the loop and the ends of each knot, all 40 knotted threads and an additional eight unknotted threads were transferred to a tensiometer to test their strength using the single-strand method. Post-knotting variables of the two groups were compared.
Knot strength (mean ± standard deviation) did not differ between the two groups (experimental group: 2.26 ± 0.50 kg vs. control group: 2.03 ± 0.94 kg; P = 0.51). The knot efficiencies of the experimental and control group were 60.6 and 54.4% (P = 0.51), respectively. However, the experimental group had a lower knot failure rate (5 vs. 40%, P = 0.02) and shorter knotting time (37.0 ± 9.2 vs. 107.0 ± 47.7 s, P < 0.001) compared with the control group.
This novel device significantly shortened the knotting time of laparoscopic intracorporeal knot tying, and did not compromise the success rate or strength of the knot.
腹腔镜下腔内打结一直被认为是腹腔镜手术中最困难的技能。我们开发了一种用于辅助腹腔镜腔内打结的新型装置，它将预系的滑结转化为安全的双页弯结。本研究的目的是检查使用这种新型装置辅助进行腹腔镜打结的可行性。
我们使用腹腔镜训练器和一块塑料人造皮肤作为实验模型。随机顺序进行 20 个腹腔镜器械辅助双页弯结（实验组）和 20 个传统腹腔镜两圈平结（对照组）。在剪断每个结的环和末端后，将所有 40 个打结线和另外 8 个未打结线转移到张力计上，使用单股法测试它们的强度。比较两组的结后变量。
两组的结强度（平均值±标准差）没有差异（实验组：2.26±0.50 kg 对对照组：2.03±0.94 kg；P=0.51）。实验组和对照组的结效率分别为 60.6%和 54.4%（P=0.51）。然而，实验组的结失败率较低（5 对 40%，P=0.02），打结时间较短（37.0±9.2 对 107.0±47.7 s，P<0.001）。
这种新型装置显著缩短了腹腔镜下腔内打结的时间，且不影响结的成功率或强度。
