Dueñas-Garcia Omar F, Sullivan Gina M, Leung Katherine, Billiar Kristen L, Flynn Michael K
Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery Division, University of Massachusetts Medical School, Worcester, MA, USA.
University of Massachusetts - UMass Memorial Medical Center, 119 Belmont Street, Worcester, MA, 01605, USA.
Int Urogynecol J. 2018 Jul;29(7):979-985. doi: 10.1007/s00192-017-3393-5. Epub 2017 Jun 20.
Surgeons use a variety of sutures and knot-tying methods during pelvic reconstructive procedures. We hypothesized that knot-strength integrity will be similar with regards to type of knot, type of suture, and the knot-tying process.
Using six different suture materials, flat square knots and slip knots were tied robotically and by hand by two surgeons. Knot integrity was evaluated using an Instron 5544 machine. We measured force and elongation at suture failure or knot slippage (whichever came first) as well as force at 3-mm displacement.
Four hundred and thirty-two knots were tie; one unraveled before the analysis, and 431 were tested. Three hundred and ninety-two knots reached or surpassed tensile strength of 30 N, the force at which tissue itself will fail. Knots tied with polyglyconate suture achieved the greatest tensile strength and those with OO-polydioxanone had the lowest. Hand-tied knots, regardless of technique and suture material, had greater tensile strength but greater elongation than robotically tied knots. Slip knots and flat square knots have similar integrity regardless of the tying technique.
Hand-tied knots had greater tensile strength than robotic knots, but the strength to break all knots required supraphysiological conditions. The decision to use a specific type of suture based on strength is not supported by our results, suggesting that surgeons may choose sutures based on other characteristics and personal comfort.
在盆腔重建手术中，外科医生会使用多种缝线和打结方法。我们假设，在结的类型、缝线类型和打结过程方面，结的强度完整性将是相似的。
使用六种不同的缝线材料，由两位外科医生通过机器人和手工方式分别打出平结和滑结。使用Instron 5544机器评估结的完整性。我们测量了缝线断裂或结滑脱（以先发生者为准）时的力和伸长量，以及位移为3毫米时的力。
共打出432个结；其中1个在分析前解开，431个接受测试。392个结达到或超过了30牛的拉伸强度，即组织本身会失效的力。使用聚乙醇酸缝线打的结具有最大的拉伸强度，而使用OO-聚二氧杂环己酮缝线打的结拉伸强度最低。无论技术和缝线材料如何，手工打的结比机器人打的结具有更大的拉伸强度，但伸长量也更大。无论打结技术如何，滑结和平结的完整性相似。
手工打的结比机器人打的结具有更大的拉伸强度，但要使所有结断裂所需的强度处于超生理条件。我们的结果不支持基于强度选择特定类型缝线的决定，这表明外科医生可能会根据其他特性和个人舒适度来选择缝线。
