Aydin Serdar, Yasli Mert
Obstetrics and Gynecology Department, Koç University Hospital, Davutpaşa Cad. No:4 Zeytinburnu, Istanbul, Turkey.
Koç University School of Medicine, Koç University, Istanbul, Turkey.
Int Urogynecol J. 2024 Nov;35(11):2227-2229. doi: 10.1007/s00192-024-05941-x. Epub 2024 Oct 1.
Challenges in intracorporeal knot tying can be addressed with extracorporeal slip knots, simplifying the process of tying and managing tissue tension using a knot pusher. However, existing extracorporeal knot techniques are difficult owing to their complexity, the finesse required with thin yarns, and extensive training needs. We developed a new laparoscopic extracorporeal slip knot technique that can be used with a conventional needle driver or standard clamps, offering the advantages of being cost-effective and easy to learn.
The technique involves passing the active strand over another loop and securing it with the nondominant hand. A Kelly clamp is then wound around both loops three times in a tornado-like motion, passing the instrument over the active loop and under the passive one, and grasping the active strand. The passive strand is pulled to approximate the knot to the tissue and is tightened by the tension of the passive strand.
This method has proven effective in various laparoscopic procedures such as sacrocolpopexy, colposuspension, pectopexy, myomectomy, and hysterectomy, facilitating surgeries without complications.
The tornado knot technique is a feasible and safely locked sliding extracorporeal knot that can be easily learned, especially by surgeons who are accustomed to open surgery.
体内打结面临的挑战可通过体外滑结来解决，使用打结器可简化打结过程并控制组织张力。然而，现有的体外打结技术因操作复杂、细线操作要求精细以及培训需求大而颇具难度。我们开发了一种新的腹腔镜体外滑结技术，该技术可与传统持针器或标准夹钳配合使用，具有成本效益高且易于学习的优点。
该技术包括将活动线穿过另一个线圈并用非优势手固定。然后用一把凯利钳以类似龙卷风的动作绕两个线圈缠绕三次，使器械从活动线圈上方穿过并从被动线圈下方穿过，然后抓住活动线。拉动被动线使结靠近组织，并通过被动线的张力将其收紧。
该方法在多种腹腔镜手术中已证明有效，如骶骨阴道固定术、阴道悬吊术、直肠固定术、子宫肌瘤切除术和子宫切除术，手术顺利无并发症。
龙卷风结技术是一种可行且安全锁定的滑动体外结，易于学习，尤其适合习惯开放手术的外科医生。
