Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida.
Vet Surg. 2020 Dec;49(8):1563-1570. doi: 10.1111/vsu.13479. Epub 2020 Jul 9.
To compare in vitro knot holding strength of the laparoscopic Miller's knot (LMK), open Miller's knot (MK), open surgeon's throw (Sx), and laparoscopic surgeon's throw (LSx) in a vascular pedicle model when used as the first throw for vascular ligation.
Experimental study.
Ten constructs each of the Miller's knot and surgeon's throw performed openly and laparoscopically with 2-0 polyglyconate suture.
Knot holding strengths of the LMK, MK, LSx, and Sx knots were evaluated on balloon dilation catheters used as vascular pedicle models. Laparoscopic knots were tied in a laparoscopic box trainer. Knot constructs were pressure tested to failure. Results were compared by Kruskal-Wallis and Steel-Dwass comparisons.
Both MK and LMK had mean leakage pressures above 300 mm Hg. The MK leaked at higher pressure than all other knots, including the LMK (P < .001). The LMK leaked at greater pressures compared with the Sx and the LSx (P < .001). No difference was detected between leaking pressures of the Sx and the LSx (P = .226), with both leaking at pressures below 40 mm Hg.
The LMK created a more secure first throw compared with the Sx and leaked at supraphysiologic pressures.
The LMK has excellent knot holding strength on a vascular pedicle model and may be further evaluated for clinical application.
比较在血管蒂模型中作为结扎第一道的腹腔镜米勒结（LMK）、开腹米勒结（MK）、开腹外科投掷（Sx）和腹腔镜外科投掷（LSx）的体外结持力。
实验研究。
各用 2-0 聚甘醇酸缝线进行开腹和腹腔镜手术的米勒结和外科投掷各 10 个构建。
在用作血管蒂模型的球囊扩张导管上评估 LMK、MK、LSx 和 Sx 结的结持力。腹腔镜结在腹腔镜箱训练器中打结。对结结构进行压力测试至失效。结果通过 Kruskal-Wallis 和 Steel-Dwass 比较进行比较。
MK 和 LMK 的平均泄漏压力均高于 300mmHg。MK 的泄漏压力高于所有其他结，包括 LMK（P<0.001）。与 Sx 和 LSx 相比，LMK 的泄漏压力更高（P<0.001）。Sx 和 LSx 的泄漏压力无差异（P=0.226），两者的泄漏压力均低于 40mmHg。
与 Sx 相比，LMK 形成了更安全的第一道投掷，并且在高于生理压力下泄漏。
LMK 在血管蒂模型上具有出色的结持力，可能进一步评估其临床应用。
