Suture Knot Research Articles

Modified delta-shaped gastroduodenostomy consisting of linear stapling and single-layer suturing with the operator positioned between the patient's legs: A technique preventing intraoperative duodenal injury and postoperative anastomotic stenosis.

BackgroundThe drawback of the delta-shaped gastroduodenostomy (DSG) in totally laparoscopic distal gastrectomy (TLDG) is the presence of intraoperative duodenal injury and postoperative anastomotic stenosis, which can occur due to a relatively short duodenal bulb diameter.Materials and methodsFrom June 2013 to June 2019, 35 patients with gastric cancer underwent TLDG with a modified DSG consisting of linear stapling and single-layer hand suturing in our institution. All anastomotic procedures were performed by the right hand of the operator positioned between the patient’s legs. Linear stapling of the posterior walls of the remnant stomach and duodenum without creating a gap was performed using a 45-mm linear stapler, considering the prevention of intraoperative duodenal injury. The stapler entry hole was closed using a single-layer full-thickness hand suturing technique with knotted sutures and a knotless barbed suture. We described the clinical data and outcomes in the present retrospective patient series.ResultsNo intraoperative duodenal injury occurred in any of the 35 patients. The median staple length at linear stapling of the posterior walls of the remnant stomach and duodenum was 41.7 ± 4.2 (30–45) mm, and 2 patients (5.7%) had a staple length of 30 mm. There were no incidences of postoperative anastomotic stenosis.ConclusionsWe suggest that a modified DSG consisting of linear stapling and single-layer hand suturing performed by an operator positioned between the patient’s legs can be one option for B-Ⅰ reconstruction following TLDG because it can aid in preventing both intraoperative duodenal injury and postoperative anastomotic stenosis.

Intrascleral sewing-machine technique: A Grooveless/flapless cyclopexy technique for large traumatic Cyclodialysis cleft repairs in pars plana vitrectomy.

To describe a minimally invasive technique for the repair of large traumatic cyclodialysis clefts using intrascleral sewing machine suture and overhand friction knot techniques in pars plana vitrectomy. This prospective, noncomparative, interventional case series included seven eyes of seven patients with a large traumatic cyclodialysis cleft. The sewing machine technique was modified by an intrascleral approach. The procedure was transconjunctival or subconjunctival performed without scleral flaps/grooves. An overhand friction knot was used to lead the cutting ends of the suture buried in the scleral tunnel. The closure of the cyclodialysis cleft was achieved in seven eyes. The mean follow-up duration was 49.1 ± 15.6 weeks (range, 30-70 weeks). The intraocular pressure increased from 7.3 ± 2.1 mm Hg (range, 5-11 mmHg) preoperatively to 13.6 ± 2.4 mm Hg (range, 10-17 mmHg) postoperatively ( P < 0.01). The best-corrected visual acuity improved from a mean of 2.76 ± 2.77 logarithm of the minimum angle of resolution preoperatively to 0.63 ± 0.82 logarithm of the minimum angle of resolution at the final follow-up ( P < 0.01). In conclusion, the present technique is safe and effective in the treatment of large traumatic cyclodialysis clefts with minimal surgical trauma and a decreased surgical duration.

A study to evaluate the safety and cost effectiveness of preformed catgut endoloops and polyglactin 910 extracorporeal ligation in the management of appendicular stump closure in laparoscopic appendicectomy

Background: The most essential component of laparoscopic appendectomy is the closure of appendicular stump. Failure of which can result in catastrophic complications including intra-abdominal and surgical site infections and rarely faecal fistula. The aim of this study was to verify the effectiveness of preformed catgut endoloop and extracorporeal polyglactin 910 for appendicular stump closure.Methods: This prospective study was carried out in 64 patients. We compared patient demographics, duration of surgery, intra and post-operative complications, hospital stay and cost of surgery between the two groups.Results: A total of sixty-four patients were finally included in the analysis, catgut group (n=34), polyglactin 910 group (n=30). The demographics between the two groups were similar. The mean age in catgut group was 23.94 years and polyglactin 910 groups was 23.33 years. Mean duration of surgery was 41.6 and 41.8 minutes in catgut and endoloop group respectively. Mean hospital stay was 3 days. There was no mortality but complications were seen in 6 patients. However, there was no statistical significance in between the two groups with any of the parameters studied.Conclusions: Multiple studies have demonstrated safety and effectiveness of various techniques of appendicular stump. The use of extracorporeal single polyglactin 910 extracorporeal suture knot is safe and cost-effective technique for closure of appendicular stump in rural and resource poor regions.

Comparison of two different suture knot techniques on postoperative morbidity after impacted mandibular third molar surgery

IntroductionIn third molar surgery, one of the most important factors is how the wound was closed. Tight suturing of the wound commonly gives more discomfort to the many patients in terms of postoperative pain, swelling and trismus. The purpose of this study is to investigate the effects of two different knot techniques in suturing after extraction of impacted mandibular third molars (IMTM) on quality of life and postoperative complications such as pain, swelling and trismus. Material and methodsThis study was conducted with a randomized and split-mouth design and included 50 patients over the age of 18 in the ASA I group who had bilateral horizontal impacted mandibular third molars. In all patients, the wounds were closed by simple sutures by applying two different knot techniques as locked (GroupL, n=50) and unlocked (Group UL, n=50) knots. In the postoperative period, pain, swelling, trismus, chewing activity and quality of life were examined. ResultsIn the group where the unlocked knotting technique was used, significantly better results were obtained in comparison to the group where the locked knotting technique was used for all values (P<0.05). ConclusionIn preventing postoperative complications that are observed after impacted mandibular third molar surgery and affect the quality of life of patients negatively, suturing of the wound by the method of unlocked knotting is a useful technique that may be preferred.

The effect of pulsed lavage irrigation on suture knot security.

The purpose of this study was to determine the effect of low-pressure and pulsed lavage irrigation on suture knot security. Ninety-tied suture loops were measured for baseline circumference and then subjected to no irrigation, bulb syringe irrigation, or pulsed lavage irrigation. The sutures were placed under a load and then measured for final circumference. A larger circumference difference indicated poorer knot security. There was a statistically significant difference in the knot security between all three groups (p < 0.001). Pulsed lavage resulted in the greatest circumference increase (0.52 ± 0.19 mm), followed by bulb syringe (0.24 ± 0.18 mm), and lastly no irrigation (0.08 ± 0.00 mm). None of the groups had any catastrophic failures. No knots met the predetermined criteria for knot failure. Pulsed lavage irrigation resulted in a statistically significant decrease in suture knot security as compared to bulb syringe irrigation and no irrigation. None of the groups met the currently accepted criteria for clinical suture failure, which has a relatively arbitrary value. While the available literature does not discuss increases in loop circumference for specific orthopedic applications, this small difference suggests that pulse lavage is unlikely to have a clinically significant impact on the suture integrity for most orthopedic procedures.

Dorsal Metacarpal Artery Perforator Flap for Skin Ulcer Due to a Postoperative Complication of Suture Anchor Treatment for Tendinous Mallet Finger

The suture anchor method of surgery has some complications. To best of our knowledge, no report on skin ulcer formation apart from the surgical site after tendinous mallet finger injury using suture anchor is available. We present the case of a 73-year-old woman who sustained tendinous mallet finger in an accident. She was treated surgically with a suture anchor. At 12 months after surgery, the string from the surgical site was removed; 28 months after surgery, a skin ulcer was formed 2-cm proximal from the operative scar, and discharge leaked from the dorsal middle phalanx. Because the wound could not heal by conservative treatment, it was treated surgically. At initial surgery, debridement of the skin ulcer, including the suture knot, was performed. At second surgery, the skin defect was reconstructed using a third dorsal metacarpal artery perforator flap. At 1 year postoperatively, she had no symptoms without recurrence.

Hemodynamic Analysis of a Microanastomosis Using Computational Fluid Dynamics.

Technical issues in free flap transfer, such as the selection of recipient vessels and the positioning and method of anastomosis of the vascular pedicle, have been the subject of vigorous debate. Recent developments in computational fluid dynamics (CFD) have enabled the analysis of blood flow within microvessels. In this study, CFD was used to analyze hemodynamics in a microanastomosis. In the fluid calculation process, the fluid domain modelizes microvessels with anastomosis. The inlet flow conditions were measured as venous waveform, and the fluid is simulated as blood. Streamlines (SL), wall shear stress (WSS), and oscillatory shear index (OSI) at the anastomosis were visualized and analyzed for observing effects from the flow field. Some flow disruption was evident as the SL passed over the sutures. The maximum recorded WSS was 13.37 Pa where the peak of a suture was exposed in the lumen. The local maximum value of the OSI was 0.182, recorded at the base of the anastomosis on the outflow side. In the ideal anastomosis, the SL is disrupted as little as possible by the sutures. The WSS indicated that thrombus formation is unlikely to occur at suture peaks, but more likely to occur at the base of sutures, where the OSI is high. Tight suture knots are important in microanastomosis.

How to convert a square knot or surgeon's knot into a sliding knot and an assessment of their sliding and re-locking properties?

Background and purposeIt is generally believed that a tight square knot or a surgeon's knot cannot be easily loosened. The objectives of this study were to explore a magic-trick-based rapid unlocking technique for tying a surgical knot, which allows restoration of the bi-directional movement of an unmovable locked knot. Material and methodsThe suture knots used included 2- and 3-throw square knots and surgeon's knots with different suture materials. The loops of four knots of various materials were tightened using the unlocking technique under simulated bone friction coefficient conditions, and the loops were observed for complete fastening of the humeral specimens. The drag forces of knot sliding (DFKS) used for different materials and different knot configurations were measured using a digital force gauge. Statistical analysis of the differences in DFKS between different knot configurations with different suture materials was performed. Main findingsExcellent loop tightening effects could be achieved for the arbitrary combination of nine sutures and four knots using this technique. The DFKS of the various knot configurations, with the same material, were as follows: 2 = 1 = 1 > 1 = 1 = 1 > 2 = 1 > 1 = 1, the DFKS of different sizes followed the order 0 silk > 2-0 silk > 3-0 silk; 0 Vicryl Plus > 2-0 Vicryl Plus > 3-0 Vicryl Plus. The DFKS for all sutures was less than 0.5 kgf. ConclusionThe rapid knot unlocking (RKU) technique can unlock any one of the double-stranded types of traceless knot. The suture loop tension can be adjusted at will. Bi-directional movement of the fast knot and the re-locking of sliding knot are solved.

Role of bandage contact lens in corneal disorders: A review

Role of bandage contact lens in corneal disorders: A review - IJOOO- Print ISSN No: - 2581-5024 Online ISSN No:- 2581-5016 Article DOI No:- 10.18231/j.ijooo.2019.060, IP International Journal of Ocular Oncology and Oculoplasty-IP Int J Ocul Oncol Oculoplasty

Suture-Based Debris Behavior in the Draining Lymph Nodes of a Porcine Knee: A Study of Silicone, Polyethylene and Carbon

PurposeTo determine whether debris from a silicone core suture has an observable intra-articular or extra-articular impact or can be shown to migrate into the lymphatic system.MethodsUsing a porcine stifle joint model, 2 study groups were created: 1 group used silicone-suture particles created by rupturing hand-tied knots of a nonabsorbable suture with an outer sheath of ultrahigh molecular-weight polyethylene, an inner polyester sheath and a medical-grade silicone/sodium chloride-filled core. The second group used a mixture of 3 vitreous carbon particles sizes. Twelve Yorkshire pigs were randomly assigned to each group. Only 1 type of study particle was used in a single animal to avoid cross-contamination. Half of the study materials were placed by arthrotomy into the joint and, after capsular closure, the remaining half were placed on the joint capsule before skin closure. Six weeks postimplantation, the stifle joints and regional lymph nodes were examined macroscopically and microscopically. The extracapsular and intra-articular tissue and the lymph nodes were examined.ResultsMacroscopically, none of the 12 silicone-suture particle group limbs had abnormal macroscopic observations. Of the 12 limbs in the carbon particle group, 8 demonstrated discoloration in the extracapsular, intra-articular and lymph node tissues; 6 limbs demonstrated joint discoloration (extracapsular and intra-articular). The silicone-suture particle group showed lymph node inflammation in 25% of the iliac lymph nodes and 42% of the inguinal lymph nodes but none in the popliteal lymph nodes. In the carbon particle group, 100% of the iliac lymph nodes, 75% of the inguinal lymph nodes and 8% of the popliteal nodes showed inflammation. No silicone-suture debris migration was observed microscopically. Visible carbon particle migration was present in 100% of the iliac lymph nodes and in 50% of the inguinal lymph nodes but in none (0) of the popliteal lymph nodes. The carbon particle group also showed inflammation in these areas.ConclusionsCarbon particles in the porcine knee migrated into the lymph nodes (iliac 100%; inguinal 50%, popliteal 0); gross discoloration was observed in 8 of 12 specimens. Silicone-suture particles could not be found in the lymph nodes, and no macroscopic joint damage was observed.Clinical RelevanceThe clinical use of a suture containing a silicone/salt central core is common, and the porcine lymphatic model suggests that this type of suture material does not result in clinically significant silicone particulates.

How to Master the Complex Task of Laparoscopic Suturing and Intra-Corporeal Knot Tying Using the Novel Clock Face Logic

Video Objective The aim was to design a reproducible, easy to adopt method for teaching laparoscopic suturing and intracorporeal knot tying. The novel use of a clock face to guide the steps is proposed to simplify & accelerate skill acquisition. The technique appears far easier to conceptualize than many others and has been very positively received during laparoscopic masterclasses conducted at the Centre for Advanced Reproductive Endo-surgery in Sydney, Australia. Setting Laparoscopic suturing requires very different and more advanced skill sets compared to suturing at open procedures. Proficiency with these skills is essential for the completion of advanced minimally invasive gynecological procedures such as hysterectomy, myomectomy and sacrocolpopexy. Inadequate laparoscopic suturing skills have been identified as a key factor impeding the use and greater adoption of minimally invasive techniques for most gynecologists. Laparoscopic suturing is one of the most difficult skills in minimally invasive surgery due to multiple factors including a constrained working field, altered depth perception, the need for counterintuitive movements and also the lack of a standardized teaching technique. Interventions This video uses images and footage from a simulation laboratory to clearly illustrate the steps involved in mastering laparoscopic suturing and intracorporeal knot tying using novel clock face directions to guide the movements. Conclusion This technique has been successfully incorporated into masterclasses run at the Centre, where anecdotally participants have grasped the concepts involved in laparoscopic suturing more quickly than with previous techniques. A prospective study is planned to compare the use of the novel clock face instructional teaching to more conventional terminology. The aim was to design a reproducible, easy to adopt method for teaching laparoscopic suturing and intracorporeal knot tying. The novel use of a clock face to guide the steps is proposed to simplify & accelerate skill acquisition. The technique appears far easier to conceptualize than many others and has been very positively received during laparoscopic masterclasses conducted at the Centre for Advanced Reproductive Endo-surgery in Sydney, Australia. Laparoscopic suturing requires very different and more advanced skill sets compared to suturing at open procedures. Proficiency with these skills is essential for the completion of advanced minimally invasive gynecological procedures such as hysterectomy, myomectomy and sacrocolpopexy. Inadequate laparoscopic suturing skills have been identified as a key factor impeding the use and greater adoption of minimally invasive techniques for most gynecologists. Laparoscopic suturing is one of the most difficult skills in minimally invasive surgery due to multiple factors including a constrained working field, altered depth perception, the need for counterintuitive movements and also the lack of a standardized teaching technique. This video uses images and footage from a simulation laboratory to clearly illustrate the steps involved in mastering laparoscopic suturing and intracorporeal knot tying using novel clock face directions to guide the movements. This technique has been successfully incorporated into masterclasses run at the Centre, where anecdotally participants have grasped the concepts involved in laparoscopic suturing more quickly than with previous techniques. A prospective study is planned to compare the use of the novel clock face instructional teaching to more conventional terminology.

1586 Laparoscopic Suturing and Knot Tying

Video Objective Although reliable knot tying is a one of the most important surgical concepts, few videos exist that illustrate how to tie a reproducible, reliable laparoscopic knot. The purpose of this video is to teach the basics of laparoscopic suturing, as well as to illustrate a reproducible method of tying reliable laparoscopic knots. Setting The video setting uses a 3-D Med laparoscopic trainer box with both standard suture and thick, color-blocked string for better demonstration. Interventions N/A Conclusion Laparoscopic suturing and intracorporeal laparoscopic knot tying is one of the most difficult, yet important, skills to learn as a beginning minimally-invasive surgeon. There are few accessible videos which teach how to correctly insert a needle, suture, and tie a reliable knot using laparoscopic tools. This video aims to teach the basics of laparoscopic suturing with the aid of color-blocked string to aid in the viewer's understanding of how to tie a proper knot.

Patella fractures treated with cannulated lag screws and fiberwire® have a high union rate and low rate of implant removal

ObjectivesThe purpose of this study is to report the results of open reduction internal fixation of patella fractures (OTA 34 A-C) using cannulated lag screws and FiberWire® (Arthrex, Naples, FL, USA) with regard to union and symptomatic implant removal. DesignRetrospective review of prospectively collected database. SettingUrban Level 1 trauma center and Level 2 trauma center MethodsAll displaced intra-articular patella fractures (OTA 34 A-C) treated with ORIF by cannulated lag screws and FiberWire® tension band/cerclage between January 1, 2009 and August 1, 2018. Three hundred and eighty seven consecutive patients were identified. Fifty fractures were included in the final analysis. Main Outcome MeasurementAll patients were followed to clinical and radiographic union. Nonunion was defined as lack of clinical and radiographic union, fracture displacement, and/or return to OR for revision surgery. Rate of symptomatic implant removal was recorded. ResultsAverage age was 57.7 years (range 21–86). Average follow up was 20.6 months (range 6–98 months). Average time to clinical and radiographic union was 3.1 months (range 3–7 months). Four fractures were open. There was a 96% (48/50) rate of primary union, with one patients requiring revision surgery to achieve union, and one developing an asymptomatic radiographic nonunion. The rate of symptomatic implant removal was 8% (4/50). Only 1 of the 4 was operated for a prominent suture knot, and the remaining 3 were for prominent screw removal. Knee range of motion averaged 0.37° extension to 119° flexion (range, 0–150°). ConclusionPatella fractures can be treated with cannulated lag screws and FiberWire® with a high rate of primary union (96%) and a low rate of symptomatic implant removal (8%). The implant removal rate compares favorably with alternative constructs, with an equivalent rate of fracture union.

An Automated Extracorporeal Knot-tying System Using Two Concentric Tube Robotic Arms for Deployment through a 3-mm Port

Ligation is a process of closing or blocking a blood vessel or duct intracorporeally to obstruct the flow of fluid before cutting it. Ligation through knot tying using a suture is a quite complex procedure and needs the use of dexterous tools to properly secure the knot. In case of natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), ligation through suture knot tying is even more difficult because of the small diameters of the accessible ports. In this study, a robotic solution for suture ligation has been proposed for possible use in SILS and NOTES. The developed device can operate through a 3-mm laparoscopic port and has a workspace of 35 × 10x5 mm (length × width x height) around the duct. The device uses a pre-tied Roeder’s knot, which is pushed down onto the duct by the operation of two concentric tube-based manipulator arms. Preliminary evaluation validates that the device can work around a phantom duct with 7 mm outer diameter without any collisions. The operation takes an average of 128.10 s with a standard deviation of 15.72 s. The knot tied is secure enough to abduct the fluid flow inside the duct, which is validated by testing on a water-filled rubber tube. The proposed device assists surgeons for suture ligation in SILS and NOTES without the requirement for any other tools and with a possibility of decreasing the operating time.

Nonabsorbable Suture Knot on the Tendon Affects Rotator Cuff Healing: A Comparative Study of the Knots on Tendon and Bone in a Rat Model of Rotator Cuff Tear

Background: Nonabsorbable suture knots are usually used to link the tendon and bone during rotator cuff repair surgery. There are many variations in the arthroscopic knot-tying technique; however, the location of suture knot placement for rotator cuff healing has rarely been studied. Hypothesis: The authors compared the rotator cuff healing between knots tied on tendon and bone in a rotator cuff tear rat model. It has been hypothesized that knots can cause chronic inflammation and create the weakest link between tendon and bone, thus affecting rotator cuff healing. Study Design: Controlled laboratory study. Methods: Bilateral supraspinatus tenotomy and rotator cuff repair at the greater tuberosity were performed on 24 Wistar rats. Nonabsorbable surgical suture knots were made on the right supraspinatus tendon tissue and left humerus inferior to the greater tuberosity, respectively. Twelve rats each were sacrificed at 3 and 9 weeks. Six of the 12 rats were used for biomechanical testing and the remaining 6 for histologic evaluation. Results: The surgical knots placed on the bursal side of the tendon migrated to the articular side, as noted on gross observation in 22 of 24 samples. The knots on the tendon group showed significantly inferior tendon-bone integration and significantly inferior biomechanical results in terms of maximum load to failure and stiffness. An obvious chronic foreign body inflammatory reaction was found in the knots on the tendon group at 3 and 9 weeks. Furthermore, inferior bone-tendon interface regeneration and weakest link formation were obtained in the knots on the tendon group compared with those on the bone group. Conclusion: Nonabsorbable suture knots placed on the tendon migrate to the articular side, causing chronic inflammation and weakening tendon-bone healing, which may explain some retears after rotator cuff repair. Clinical Relevance: The present animal study suggests that it is not recommended in clinical practice to make several bulky nonabsorbable suture knots on the rotator cuff tendon during rotator cuff repair surgery. It may be better to tie the knots at the bone side or do knotless repair.

Arthroscopic Repair of Type II SLAP Lesions in Overhead Athletes

For overhead athletes and, in particular, baseball pitchers, the rates of success and return to play for those who have undergone arthroscopic repair of type II SLAP lesions are poor, ranging from 7% to 62%. The reasons for the poor results and high failure rates in overhead athletes with type II SLAP repairs are multifactorial and are a combination of many factors. These factors include the failure to establish the diagnosis and treat these athletes preoperatively; the inability of the operating surgeon to differentiate normal anatomic variants from pathologic SLAP lesions at the time of surgery; the surgical technique, which may violate the rotator cuff; or the placement of suture anchors, which restricts external rotation and alters overhead throwing mechanics. The proper diagnosis of SLAP lesions can be difficult because SLAP tears rarely occur in isolation and are often associated with other shoulder pathology. A proper history detailing the onset of symptoms and whether there was an acute episode of trauma or a history of repetitive use is critical. It is important to remember that no single physical examination finding is pathognomonic for SLAP tears. When seen in isolation, SLAP tears may mimic impingement syndrome (52%) or even anterior instability (39%). Surgical treatment of type II SLAP lesions should not be undertaken lightly in overhead athletes. If a 3-month rehabilitation period followed by a return to sports over the following 3 months does not allow the athlete to return to his or her preinjury level, diagnostic arthroscopy with SLAP repair is a reasonable option and can yield excellent results using the proper techniques. The technique described in detail in this article and our video can be technically demanding, but with the key points outlined, it can be reproduced and provide excellent results for overhead athletes undergoing SLAP repair. By not violating the rotator cuff, using a mattress configuration and keeping the suture knot away from the articular surface, and by not going anterior to the biceps tendon for repair, external rotation and strength can be preserved, leading to an excellent result with a predictable return to play for overhead athletes.

Acute Triceps Tendon Repair: A Technique Utilizing 3 Curved Tunnels and Proximal Knots

Although triceps tendon tears are less common than other tendon tears, complete ruptures require surgical repair to restore the strength of the extensor mechanism of the elbow. There are several described techniques for repair using both transosseous tunnels and suture anchors. Current techniques often result in large suture knots over the dorsal ulna under thin subcutaneous tissue, which can be irritating for patients. Knotless techniques require costly suture anchors. In this technical note, we describe a novel transosseous 3-tunnel technique with proximal suture knots to lessen the potential for postoperative pain.

Single-port laparoscopic percutaneous extraperitoneal closure of inguinal hernia using "two-hooked" core needle apparatus in children.

The aim of this study is to evaluate the surgical outcomes of single-port laparoscopic percutaneous extraperitoneal closure of inguinal hernia using "two-hooked" core needle apparatus in children. This study was conducted at Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine between January 2016 and June 2018. Five hundred and eighteen patients under the age of 12years with inguinal hernias were subjected to single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) using non-absorbable suture by "two-hooked" core needle apparatus. Description of the technique is as follows: Under general anesthesia, a 0.5-0.8cm trans-umbilical skin incision was done for insertion of a 0.5cm port. A "two-hooked" core needle apparatus was used for insertion of a non-absorbable suture around internal ring. The suture knot was tied extracorporeally. Among 518 child patients with inguinal hernias, there were 406 males and 112 females with a mean age of 4.6 ± 3.5years. One hundred and six cases were subjected to bilateral surgery including 91 cases of contralateral patent processus vaginalis (PPV). Three cases converted to open surgery and additional 0.5cm port was done in five cases. The mean operative time was 13.2 ± 3.5min for unilateral hernia repair and 16.9 ± 4.6min for bilateral cases. All patients achieved full recovery without complications such as surgical site infection (SSI), testicular atrophy, or iatrogenic ascent of the testis. At the mean follow-up time of 18.72 ± 5.27 months, two cases had recurrences (0.39%) and one case had postoperative hydrocele (0.19%). SPLPEC of inguinal hernia using "two-hooked" core needle apparatus in children is a feasible and reliable minimal invasive procedure. It has the advantages of short operating time, low complication rate, low recurrence rate and better cosmetic result.

Vision-Based Surgical Suture Looping Through Trajectory Planning for Wound Suturing

Robot-assisted surgery has revolutionized the field of surgery over the past few decades. Despite many successes, achieving full automation in these surgeries remains a challenging task. In this paper, a dynamic approach is proposed to automate knot tying with an in-house robot vision system. Through efficient path planning and coordination between two grippers, the workspace required for constructing the suture loop can be reduced while issues such as suture slippage and collisions between instruments can be eliminated. Visual images were employed to monitor the two grippers in real time and their positions were evaluated using transformation matrices obtained experimentally. A linear quadratic control scheme was applied to optimize the tracking performance of the two grippers. From the experiments, this visual evaluation method can achieve a position accuracy of 1 mm in the workspace. The proposed algorithm was evaluated and automatic suture looping operation was successfully performed in all six trials. Different parameters in the control scheme were also examined by introducing external impulse disturbances during the knot-tying process. This proposed knot-tying approach demonstrates a simple and efficient way to construct a suture knot in a minimal workspace. Note to Practitioners —A surgical operation usually takes several hours to complete, which is a test of surgeon’s endurance. To better assist surgeons, several repetitive surgical tasks can be performed automatically with a robotic system. This paper presents a new method for robot-assisted surgical knot tying in a confined environment. Through simultaneous manipulation and trajectory planning of the two surgical grippers, suture loops were constructed while keeping the suture in tension. Images were employed to guide the gripers in completing the knot-tying process with high precision. Experiments were conducted to demonstrate the automated suture looping operation with the system and the proposed method. The robustness of the method was also examined by introducing impulse disturbances and occlusions during the experiments. This proposed method does not require complicated hardware setup, allowing easy implementations on various surgical systems.

Biomechanical Properties of a Novel Mesh Suture in a Cadaveric Flexor Tendon Repair Model

Conventional suture repairs, when stressed, fail by suture rupture, knot slippage, or suture pull-through, when the suture cuts through the intervening tissue. The purpose of this study was to compare the biomechanical properties of flexor tendon repairs using a novel mesh suture with traditional suture repairs. Sixty human cadaveric flexor digitorum profundus tendons were harvested and assigned to 1 of 3 suture repair groups: 3-0 and 4-0 braided poly-blend suture or 1-mm diameter mesh suture. All tendons were repaired using a 4-strand core cruciate suture configuration. Each tendon repair underwent linear loading or cyclic loading until failure. Outcome measures included yield strength, ultimate strength, the number of cycles and load required to achieve 1-mm and 2-mm gap formation, and failure. Mesh suture repairs had significantly higher yield and ultimate force values when compared with 3-0 and 4-0 braided poly-blend suture repairs under linear testing. The average force required to produce repair gaps was significantly higher in mesh suture repairs than in conventional suture. Mesh suture repairs endured a significantly greater number of cycles and force applied before failure compared with both 3-0 and 4-0 conventional suture. This exvivo biomechanical study of flexor tendon repairs using a novel mesh suture reveals significant increases in average yield strength, ultimate strength, and average force required for gap formation and repair failure with mesh suture repairs compared with conventional sutures. Mesh suture-based flexor tendon repairs could lead to improved healing at earlier time points. The findings could allow for earlier mobilization, decreased adhesion formation, and lower rupture rates after flexor tendon repairs.