Department of Gynecology, Sugisawa Medical Center and Vita Batel Hospital, Curitiba, Paraná, Brazil.
Department of Gynecology, Sugisawa Medical Center and Vita Batel Hospital, Curitiba, Paraná, Brazil.
J Minim Invasive Gynecol. 2018 Jul-Aug;25(5):773. doi: 10.1016/j.jmig.2017.10.032. Epub 2017 Nov 7.
To demonstrate the application of different knot blocking sequences in laparoscopic surgery.
A step-by-step demonstration of different blocking sequences performed by laparoscopic surgery (Canadian Task Force classification III).
Private hospital in Curitiba, Paraná, Brazil.
The correct placement of one knot over the other is rarely taught in the surgical literature. Laparoscopic knot-tying techniques may be performed using one hand (monomanual technique) or alternating both hands (bimanual technique). Rotation of the needle holders around the thread (clockwise or counterclockwise rotation) is very important to have a symmetric or an asymmetric configuration of the knot, which affects the stability of the entire knot sequence. The monomanual knot-tying technique needs to alternate the rotation of the needle holder, and the bimanual technique does not when performing half knots (square or flat knots). The half hitch is an asymmetric knot that is obtained when the surgeon makes asymmetric traction on one thread (passive thread) and place the knot using the other thread (active thread). To block 2 half hitches, the surgeon needs to change the active and the passive threads. Beginners in laparoscopy commonly make mistakes tying knots, leading to an insecure knot sequence that may slip and/or open under minimal forces. In this video, we demonstrate different types of blocking sequences performed by laparoscopy applied in different surgical procedures. Ethics Committee approval was obtained for this video.
Knot-tying is a basic surgical skill that must be mastered by all laparoscopists.
展示腹腔镜手术中不同打结阻断序列的应用。
腹腔镜手术中不同阻断序列的分步演示（加拿大外科医师学会分类 III 级）。
巴西巴拉那库里蒂巴的一家私人医院。
手术文献中很少教授如何正确地将一个结套在另一个结上。腹腔镜打结技术可以用一只手（单手技术）或双手交替（双手技术）进行。针持器围绕缝线的旋转（顺时针或逆时针旋转）对于形成对称或非对称的结构型非常重要，这会影响整个结序列的稳定性。单手打结技术需要交替旋转针持器，而双手技术在进行半结（方结或平结）时则不需要。半结是一种非对称结，当外科医生对一根缝线（被动缝线）施加不对称的牵引力并用另一根缝线（主动缝线）打结时，就会形成半结。要阻断 2 个半结，外科医生需要更换主动缝线和被动缝线。腹腔镜初学者在打结时经常犯错误，导致结序列不牢固，在最小的力下可能会滑动和/或打开。在这个视频中，我们展示了腹腔镜应用于不同手术程序的不同类型的阻断序列。本视频已获得伦理委员会的批准。
打结是所有腹腔镜医师都必须掌握的基本外科技能。
