Sliding Knot Research Articles

Ligature Technique: A Safe Outcome in Laparoscopic Cholecystectomy

Objective: To compare Extracorporeal Sliding knot (ECK) and clip ligation to ligation of the cystic duct in laparoscopic cholecystectomy. Patients and Methods: This study was conducted as prospective randomized study in Jeddah National Hospital in Jeddah Saudi Arabia, in surgical department carried out from June 2018 to June 2019. In the study 100 patients were selected and divided into two groups, in which we compared outcomes of patients in whom Cystic Duct Occlusion was done by clips (Group I n=60) and other group Ligatures endoloop knotting (Group II n=40). During laparoscopic cholecystectomy (LC), cystic duct occlusion can be done with titanium clips or ligature permanently in order to prevent leakage of bile into the peritoneal cavity. Results: Average age of the patients of clipping group was 43.68 years and the average age of the patients of knot group was 42.64 years, with male to female ration as 1:4.5. 1:2.3 of clipping and knot group respectively. Regarding operating time from initial incision to closure of wound is 61 to 65 minutes in clip group and 69 to 70 minutes in knot group. Longer operating times in knot group is due to learning curve effect for most surgeons as is evident from the fact that first twenty surgeries took longer time as compared to subsequent surgeries. The port site infection was in 03 cases of the clip group 01 in the knot group, drain was kept in 12 cases in knot group and 06 in clip group, bile leak requiring ERCP 02 cases in clip group and 01 in knot group, retained CBD Stones 01 was in clip group, obstructive Jaundice was seen in one cases of clip group, while no mortality was seen in both groups. Although the hospital stay after surgery in clip group was 1-2 days and in knot group also 1-2 days and in ERCP patients’ Hospital stay was 2 to 3 days. Conclusion: Cystic duct occlusion with knots/ligatures is a safe, cost effective, less post operative pain alternative to clips as various studies showed clips complications. It also showed less post-operative pain, less bile leak and port site wound infection. Safety of using knots/ligatures is even better than clips as is evident from this study comparing these two methods of cystic duct occlusion. Key words: cholecystectomy, surgical clips, surgical knots, surgical ligature, cystic duct occlusion, bile leakage

Modified Percutaneous Repair of Acute Achilles Tendon Rupture: A Sliding Knot Technique Using Absorbable Suture

Modified Percutaneous Repair of Acute Achilles Tendon Rupture: A Sliding Knot Technique Using Absorbable Suture

Osaka Sliding Knot Seals Dural Defect Simply in Extended Endoscopic Endonasal Approach

An extended endoscopic endonasal approach (EEA) has become standard for parasellar and midline skull base lesions. However, postoperative leakage of cerebrospinal fluid (CSF) can result from dural defects after lesion removal. We present a simple and effective technique, the Osaka sliding knot, to prevent CSF leakage. Between November 2018 and March 2021, a total of 41 patients underwent reconstruction of skull base defects with intraoperative high-flow CSF leaks after extended EEA by using this closure technique, of whom only 1 patient experienced postoperative CSF leakage. This technically simple and efficient method seals the dural defect to prevent CSF leakage after surgeries using an extended EEA.

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review.

Background:Knot tying is a crucial component of successful arthroscopic shoulder surgery. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes.Purpose:To assess the clinical outcomes of arthroscopic sliding knot (SK)– versus nonsliding knot (NSK)–tying techniques during arthroscopic shoulder surgery, including rotator cuff repair, Bankart repair, and superior labral anterior-posterior (SLAP) repair.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic search of the PubMed, Embase, and Cochrane Library databases was performed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All English-language literature published between 2000 and 2018 reporting clinical outcomes utilizing SK- or NSK-tying techniques during rotator cuff repair, Bankart repair, and SLAP repair with a minimum 24-month follow-up was reviewed by 2 independent reviewers. Information on type of surgery, knot used, failure rate, patient satisfaction, and patient-reported outcomes was collected. Patient-reported outcome measures included the Constant-Murley score, Rowe score, and visual analog scale for pain. Study quality was evaluated using the modified Coleman Methodology Score.Results:Overall, 9 studies (6 level 3 and 3 level 4) with a total of 671 patients (mean age, 52.8 years [range, 16-86 years]; 65.7% male; 206 SK and 465 NSK) were included. There were 4 studies that reported on Bankart repair in 148 patients (63 SK and 85 NSK), 3 on SLAP repair in 59 patients (59 SK), and 2 on rotator cuff repair in 464 patients (84 SK and 380 NSK). Also, 6 studies compared knot-tying with knotless techniques (3 Bankart repair studies and 3 SLAP repair studies), while the studies reporting the outcomes of SLAP repair evaluated SK-tying techniques only. The failure rate for Bankart repair was 3.2% (2/63) for SKs and 4.7% (4/85) for NSKs. The failure rate for rotator cuff repair was 2.4% (2/84) for SKs and 6.3% (24/380) for NSKs. The failure rate for SLAP repair was 11.9% (7/59). Because of inconsistencies in outcomes and procedures, no quantitative analysis was possible. The mean modified Coleman Methodology Score for all studies was 65.1 ± 8.77, indicating adequate methodology.Conclusion:The literature on clinical outcomes using SKs or NSKs for shoulder procedures is limited to level 4 evidence. Future studies should be prospective and focus on comparing the use of SKs and NSKs for shoulder procedures to elucidate which arthroscopic knot results in superior clinical outcomes.

A Biomechanical and Ease of Learning Comparison Study of Arthroscopic Sliding Knots.

This study aims to compare the biomechanical properties and ease of learning and tying of our novel knot (UM Knot) with other commonly used arthroscopic sliding knots. The Duncan, HU, SMC, Pretzel, Nicky's and square knots were selected for comparisons with UM knot. All knots were prepared with size 2 HiFi® suture by a single experienced surgeon and tested with cyclic loading and load to failure tests. The ease of learning was assessed objectively by recording the time to learn the first correct knot and the total number of knots completed in 5min by surgeons and trainees. The UM knot average failure load is significantly superior to the HU knot (p < 0.05) and comparable to Duncan, SMC, Pretzel and Nicky's knots. According to the ease of learning assessment, UM, Duncan, SMC, Pretzel and Nicky's knots took statistically less time to learn than the HU knot. Although not significant, the failure count due to slippage is fewer in UM knot compared with other knots. This study showed that UM knot is among the easiest knot to learn and tie, along with Duncan, SMC, Pretzel and Nicky's knots. Their biomechanical properties are comparable and their loads to failure were superior to the HU knot.

Self-locking Sliding Knots in Laparoscopic Bariatric Sutures

Self-locking Sliding Knots in Laparoscopic Bariatric Sutures

Ligation of the Rectum with an Extracorporeal Sliding Knot Facilitating Laparoscopic Cross-Stapling: A Procedure Revisited

Multiple stapler firings during distal rectal division were associated with unduly long stapler line and anastomotic leakage after laparoscopic rectal resection. A simple and relatively easy technique to perform a safe transection of rectum is presented. The extracorporeal ligation of the rectum just proximal to the cut end of the rectum before applying the linear stapling stapler facilitates the procedure and requires only a few firings of the stapler during the laparoscopic rectal resections. Ten patients with a median age of 72 years underwent rectal transection with this technique. The procedure was performed with a single 60-mm cartridge in 3 patients, and two firings of the Endo GIA™ (Covidien LLC, Mansfield, MA) with a 45-mm cartridge were necessary for cross-stapling at the level of the pelvic floor in the remaining patients. There were no intraoperative complications. Postoperative complications were seen in 2 patients. This simple technique theoretically seems safer than the conventional approach and should be considered as an additional option for rectal transection.

Self-Locking Sliding Knot to Manage Upper Third Molar Extraction

Arcuri, Francesco MD; Brucoli, Matteo MD; Nicolotti, Matteo MD; Benech, Arnaldo MD, PhD Author Information

Paper 144: Arthroscopic Sliding Knot: How Many Additional Half Hitches Are Really Needed?

Paper 144: Arthroscopic Sliding Knot: How Many Additional Half Hitches Are Really Needed?

Arthroscopic Bankart Repair Using Knotless Anchor that Contains a Self-lock Sliding Knot in the Anchor

Arthroscopic Bankart Repair Using Knotless Anchor that Contains a Self-lock Sliding Knot in the Anchor

The Peruvian Fisherman's Knot A New Simple, and Versatile Self-Locking Sliding Knot

The Peruvian Fisherman's Knot A New Simple, and Versatile Self-Locking Sliding Knot

Extracorporeal “Giant” Locking Sliding Knot in Pediatric and Neonatal Minimally Invasive Surgery: Indications, Techniques, and Outcomes

A prospective study to assess the clinical application of extracorporeal "Giant" locking sliding knot (GLSK) in pediatric and neonatal minimally invasive surgery (MIS). A total of 152 MIS, of various complexities were performed over a 14-month period with more than 1100 GLSKs used in 126 procedures. There were no major complications or deaths in this cohort. Unraveling of the GLSK was observed in three instances (0.3%) secondary to excessive manipulation. Only a copolymer of glycolic acid/trimethylene carbonate material (Maxon suture; Covidien, Norwalk, CT) and polyproplene (Prolene suture; Ethicon, Sommerville, NJ) can be used for the GLSK technique due to their very smooth surface. Extracorporeal GLSKs can replace intracorporeal knots because they are safe, faster to tie, and reduce the surgeon's fatigue during complex MIS.

Approximating Tissue Under Tension Using the Slipped Square Sliding Knot

TECHNIQUE While preparing the tibial plateau for resection, the knee is fully flexed with retraction of the distal femur and soft tissues to expose the area adequately. This is generally done using a singleand double-pronged retractor held by an assistant. In our technique, the double-pronged retractor is held using a pair of Kocher’s forceps passed through the proximal hole in the retractor and attached to the drapes. The single-pronged retractor may then be positioned to retract the lateral soft tissues. This is held in position by a second pair of Kocher’s forceps, the jaws of which are closed around the double-pronged retractor, with the single-pronged retractor held between the two handles, against the ratchet mechanism of the forceps (Fig. 1). DISCUSSION With the advent of the European Working Time Directive, it has become increasingly difficult to acquire the services of an assistant in theatre. Joint exposure is an extremely important step in total knee arthroplasty that requires adequate retraction to show the tibial plateau. We feel that when assistance is unavailable, the described technique provides reliable exposure during this vital step in the procedure.

Removal of a Broken Locking Screw From the Intramedullary Canal Using a Sliding Knot

A locking screw lost in the intramedullary canal during extraction of an intramedullary nail is not an uncommon problem. This report describes a simple procedure using sliding wire knot and an Ender nail for removing a broken locking screw from the intramedullary canal. This method allows the easy removal of a broken locking screw from the intramedullary canal without a special instrument.

The HU Knot: A New Sliding Knot for Arthroscopic Surgery

Sliding knots are commonly used in arthroscopic knot tying. The Surgical knot as a hand-tied knot is very secure. We found that the Surgical knot could be used as a sliding knot. We have modified the Surgical knot to include a self-locking loop. A new sliding knot for arthroscopic surgery, the HU knot, is described. By tensioning the loop strand, the self-locking loop creates a snug knot without sliding backward. The HU knot provides great security.

Knot Integrity With Nonidentical and Parallel Sliding Knots

Abstract Objective The study was performed to test the knot integrity of parallel and nonidentical sliding knots with the use of monofilament suture. Study design We investigated the proportion of parallel sliding knots that become untied compared with nonidentical sliding knots in four different monofilament suture configurations: group A, 6 throws, 0-0 gauge; group B, 10 throws, 0-0 gauge; group C, 6 throws, 2-0 gauge; group D, 10 throws, 2-0 gauge. Each combination was tested 20 times, for a total of 160 knots. Results The nonidentical sliding knot untied 40% of the time in group A compared with 0% for the parallel knot (P = .003). In the other 6-throw group, group C, 45% of the nonidentical knots became untied compared with 0% of the parallel knots (P = .001). There were no significant differences in the proportions of untying for each knot type in the 10-throw groups. Conclusion Parallel sliding knots demonstrate superior knot integrity compared with nonidentical sliding knots with monofilament suture. The addition of throws to the nonidentical knot improves its knot security.

A Biomechanical Comparison of Arthroscopic Sliding and Sliding-Locking Knots: An Analysis of Knot Security and Strength (SS-25)

A Biomechanical Comparison of Arthroscopic Sliding and Sliding-Locking Knots: An Analysis of Knot Security and Strength (SS-25)

TECHNICAL NOTE: A “NEW” ARTHROSCOPIC SLIDING KNOT

Sliding knots are an essential element of arthroscopic shoulder surgery. The authors have been using a previously undescribed arthroscopic sliding knot with good clinical success. This knot has been used in arthroscopic rotator cuff repair, arthroscopic shoulder stabilization, and arthroscopic SLAP repair. The technique of this knot is illustrated.

Technical note: A “new” arthroscopic sliding knot

Sliding knots are an essential element of arthroscopic shoulder surgery. The authors have been using a previously undescribed arthroscopic sliding knot with good clinical success. This knot has been used in arthroscopic rotator cuff repair, arthroscopic shoulder stabilization, and arthroscopic SLAP repair. The technique of this knot is illustrated.

Knot Properties of Alternating Sliding Knots with Different Patterns in Comparison to Alternating and Simple Sliding Knots

This study attempts to compare the alternating sliding knots with different patterns with the alternating and simple sliding knots. Silk and nylon sutures of 2–0 and 4–0 United States Pharmacopeia (USP) sizes were mechanically tested. The values of knot holding capacities (KHCs) varied depending on knot configuration, suture material, and size. The parallel alternating knot with different patterns showed a high KHC for silk suture of both sizes. For nylon, the alternating knots with different patterns were comparable to the simple sliding knots. When we compared silk with nylon in knots with different patterns we observed the following. For size 2–0 loops, the nonidentical knot of nylon was higher in KHC than that of silk, and the parallel knot of silk was higher in KHC than that of nylon. Loops of 4–0 showed higher KHCs for the parallel knot in nylon than in silk but similar values for both materials with the nonidentical knot. The parallel alternating knot with different patterns was the most efficient for nylon 4–0. The silk loops had good efficiencies for both sizes. The silk suture knots were all reliable. The nylon suture showed unreliability for the parallel and alternating nonidentical knots of both sizes and the alternating parallel knot in 2–0 suture. The results section discusses the physical structure and suture dimension. This study did not prove that the strength of the knot increases with complexity.