Amano Kosaku, Okada Yoshikazu, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Neurosurg Rev. 2019 Jun;42(2):593-598. doi: 10.1007/s10143-019-01090-8. Epub 2019 Mar 1.
Transsphenoidal surgery (TSS) has become a well-established standard surgical technique, but the cerebrospinal fluid leakage remains controversial. Direct suturing of the dura, which is a routine procedure within transcranial surgery, can be applied for closure of the sella turcica within TSS. However, as the dura is not accessible by the index finger, knot tying in the narrow and deep surgical corridor following dural suturing is extremely difficult, cumbersome, and time-consuming in TSS. Here, we present a new, simple, and effective technique for knot tying using our newly developed instrument the "knot tightener" (UC-6603: Medical U & A, Inc., Osaka, Japan) to solve this challenge. The knot tightener has a total length of 235 mm and is bayonet shaped. The tip is 5 × 10 mm in diameter and has one long arm and two short curved arms. The long arm has a dimple which can hook and hold a thread, fulfilling the role of an index finger. Together the two short curved arms make a half circle and are able to hook a thread easily. From the 28th of March 2011 to August 2018, we used the knot-tightener device for 566 patients who underwent endonasal TSS, to deliver and tie knots following stitching of the dura using 6-0 nylon. The device was able to easily deliver a knot from outside of the nostril to the sella turcica through the nasal cavity and successfully tighten it firmly. No complications were observed, confirming the safety of the newly designed instrument. The knot tightener can be considered to be an optimal tool for the challenging surgical procedure of knot tying following dural suturing in TSS. Its potential future applications may extend to include other neurosurgical procedures in anatomically restricted areas.
经蝶窦手术（TSS）已成为一种成熟的标准外科技术，但脑脊液漏问题仍存在争议。硬脑膜直接缝合是经颅手术中的常规操作，可用于经蝶窦手术中鞍底的封闭。然而，由于食指无法触及硬脑膜，在经蝶窦手术中，硬脑膜缝合后在狭窄且深的手术通道内打结极其困难、繁琐且耗时。在此，我们介绍一种新的、简单且有效的打结技术，使用我们新开发的器械“打结器”（UC - 6603：Medical U & A，Inc.，日本大阪）来应对这一挑战。该打结器全长235毫米，呈刺刀状。尖端直径为5×10毫米，有一个长臂和两个短弯臂。长臂上有一个凹痕，可以钩住并固定一根线，起到食指的作用。两个短弯臂共同形成一个半圆，能够轻松钩住一根线。从2011年3月28日至2018年8月，我们对566例行鼻内镜经蝶窦手术的患者使用了该打结器，在使用6 - 0尼龙线缝合硬脑膜后传递并打结。该器械能够轻松地从鼻孔外部通过鼻腔将结传递到鞍底并成功牢固收紧。未观察到并发症，证实了新设计器械的安全性。对于经蝶窦手术中硬脑膜缝合后具有挑战性的打结手术，打结器可被视为一种最佳工具。其未来潜在应用可能会扩展到包括解剖结构受限区域的其他神经外科手术。
