From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu).
Can J Surg. 2021 Feb 3;64(1):E59-E65. doi: 10.1503/cjs.016719.
Square knots can be difficult to construct in deep body cavities. The reversing half-hitch alternating post (RHAP) surgical knot has noninferior tensile strength and performance characteristics in deep body cavities. We compared the enterotomy repairs of novice learners in simulated deep body cavities using RHAP versus square knots after proficiency-based training.
Undergraduate students were randomized to RHAP (n = 10) or square knot (n = 10) groups and trained to defined proficiency. They then performed hand-sewn enterotomy repairs of cadaveric porcine small bowels on flat surfaces and in simulated deep body cavities. We recorded time to knot-tying proficiency and to enterotomy repair, and burst pressures for the repair.
Mean time-to-proficiency in knot tying was equivalent between the RHAP and square knot groups (23 [standard deviation (SD) 3] v. 21 [SD 2] min, p = 0.33). Mean time for enterotomy repair in deep cavities was shorter for the RHAP group (16 [SD 2] min v. 21 [SD 1] min, p = 0.02). Mean burst pressures for enterotomy repair were equivalent on flat surfaces (128 [SD 41] v. 101 [SD 36] mm Hg, p = 0.31), and were significantly higher for the RHAP group in simulated deep body cavities (32 [SD 13] v. 105 [SD 37] mm Hg, p = 0.05).
The RHAP knots appear to have superior performance versus square knots when tied in a deep body cavity by novice learners. Future work should focus on demonstrating the clinical relevance and broad utility of the RHAP knot in abdominal surgery. Both knot types should be taught to novice learners.
在深部体腔中，方结的构建可能较为困难。在深部体腔中，RHAP 倒半结交替后结（RHAP）手术结具有不劣于的抗张强度和性能特征。在基于熟练度的培训后，我们比较了新手学习者在模拟深部体腔中使用 RHAP 与方结进行肠切开修复的效果。
将本科生随机分为 RHAP（n = 10）或方结（n = 10）组，并进行训练以达到特定的熟练度。然后，他们在平面和模拟深部体腔中对猪小肠的尸体进行手工肠切开修复。我们记录了打结达到熟练程度的时间和肠切开修复的时间，以及修复的破裂压力。
RHAP 和方结组达到熟练程度的平均时间相当（23 [标准差（SD）3] 分钟对 21 [SD 2] 分钟，p = 0.33）。在深部体腔中进行肠切开修复的平均时间 RHAP 组较短（16 [SD 2] 分钟对 21 [SD 1] 分钟，p = 0.02）。平面上的肠切开修复破裂压力相当（128 [SD 41] 毫米汞柱对 101 [SD 36] 毫米汞柱，p = 0.31），而在模拟深部体腔中，RHAP 组的破裂压力明显更高（32 [SD 13] 毫米汞柱对 105 [SD 37] 毫米汞柱，p = 0.05）。
对于新手学习者来说，在深部体腔中打结时，RHAP 结似乎比方结具有更好的性能。未来的研究应集中于证明 RHAP 结在腹部手术中的临床相关性和广泛实用性。应向新手学习者教授这两种结。
