Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches

Author:

Koninckx Philippe R.1234ORCID,Ussia Anastasia5,Wattiez Arnaud46,Kondo William7,Romeo Armando8

Affiliation:

1. Department of OBGYN, Faculty of Medicine, Katholieke University Leuven, 3000 Leuven, Belgium

2. Department of OBGYN, Faculty of Medicine, University of Oxford, Oxford OX1 2JD, UK

3. Department of OBGYN, Faculty of Medicine, University Cattolica, del Sacro Cuore, 00168 Rome, Italy

4. Latifa Hospital, Dubai 9115, United Arab Emirates

5. Department of OBGYN, Gemelli Hospitals, Università Cattolica, 00168 Rome, Italy

6. Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France

7. Centro Avançado de Cirurgia Ginecológica, Curitiba 81020-430, Brazil

8. Project Leader Research Educational Center, University of Turin, 10124 Torino, Italy

Abstract

Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing the active and passive ends has the same effect as changing the rotation. Loop security is the force to keep tissue together after a first half-knot or sliding half-hitches. With polyfilament sutures, H2, H3, SSs, and SSsSsSs have a loop security of 10, 18, 28, and 48 Newton (N), respectively. With monofilament sutures, they are only 7, 16, 18, and 25 N. Since many knots can reorganize, the definition of knot security as the force at which the knot opens or the suture breaks should be replaced by the clinically more relevant percentage of clinically dangerous and insecure knots. Secure knots with polyfilament sutures require a minimum of four or five throws, but the risk of destabilization is high. With monofilament sutures, only two symmetric+4 asymmetric blocking half-hitches are secure. In conclusion, in gynecology and in open and laparoscopic surgery, half-hitch sequences are recommended because they are mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilization.

Publisher

MDPI AG

Subject

General Medicine

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