Abstract
This new instrument is a metal cannula designed for use in creating controlled intracorporeal knots similar to instrument ties used in open surgery. It can therefore be used in a number of situations in laparoscopic surgery for ligation in continuity—for example, of the undivided cystic duct or of a vascular pedicle or for ligation of the cut end of a pedicle held in artery forceps. The cannuala is designed to be loaded with 0 suture material and has a tip that readily penetrates the abdominal wall through a 3-mm skin incision, so it can be introduced either directly or through an introducer sleeve in a laparoscopic port. A curved dissecting forceps is used for knot formation. The knot is tightened by pushing the cannula with the other hand, and further throws are applied. The tip is profiled so that the knot, which is formed is pushed down into position without slippage or damage to the suture material.
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References
Arnaud JP, Bergamaschi R (1993) Migration and slippage of metal clips after celioscopic cholecystectomy. Surg Lap Endosc 3: 487–488
Kadirkamanathan SS, Laufer JG, Hepworth CC, Gong F, Swain CD (1994) A comparison of the strength of knots tied by hand, at laparoscopy and flexible endoscopy. Min Inv Ther 3: 46
Miller SS (1994) Laparoscopic instrument tie. Br J Surg 81: 1360–1361
Nathanson LK (1990) Instrumentation and basic operative techniques for laparoscopic surgery. In: Cushieri A, Berci G (eds) Laparoscopic biliary surgery. Blackwell Scientific Publications, Oxford, pp 15–37
Odell RC (1993) Laparoscopic electrosurgery. In: Hunter JG. Sackier JM (eds) Minimally invasive surgery. McGraw-Hill, New York, pp 33–42
Semm K, Freys I (1991) Endoscopic appendectomy: technical operative steps. Min Inv Ther 1: 41–50
Shimi SM, Lirici M, Cushieri A (1994) In vitro study of extracorporeal slip knots used in endoscopic surgery. J R Coll Surg Edinb 39: 385
Woods MS, Shellito JL, Santoscoy GS, Hagan RC, Kilgore WR, Traverso W, Kozarek RA, Brandabur JJ (1994) Cystic duct leaks in laparoscopic cholecystectomy. Am J Surg 168: 560–565
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Miller, S.S. A new reusable instrument designed for simple and secure knot tying in laparoscopic surgery. Surg Endosc 10, 940–941 (1996). https://doi.org/10.1007/BF00188490
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DOI: https://doi.org/10.1007/BF00188490