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In vitro holding strength of the laparoscopic Miller's knot compared with open Miller's knot, open surgeon's throw, and laparoscopic surgeon's throw in a vascular pedicle model
Author(s) -
Erickson Andrea K.,
FoxAlvarez W. Alexander,
Regier Penny J.,
Case J. Brad
Publication year - 2020
Publication title -
veterinary surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.652
H-Index - 79
eISSN - 1532-950X
pISSN - 0161-3499
DOI - 10.1111/vsu.13479
Subject(s) - medicine , knot (papermaking) , surgery , engineering , chemical engineering
Abstract Objective To compare in vitro knot holding strength of the laparoscopic Miller's knot (LMK), open Miller's knot (MK), open surgeon's throw (Sx), and laparoscopic surgeon's throw (LSx) in a vascular pedicle model when used as the first throw for vascular ligation. Study design Experimental study. Sample population Ten constructs each of the Miller's knot and surgeon's throw performed openly and laparoscopically with 2‐0 polyglyconate suture. Methods Knot holding strengths of the LMK, MK, LSx, and Sx knots were evaluated on balloon dilation catheters used as vascular pedicle models. Laparoscopic knots were tied in a laparoscopic box trainer. Knot constructs were pressure tested to failure. Results were compared by Kruskal‐Wallis and Steel‐Dwass comparisons. Results Both MK and LMK had mean leakage pressures above 300 mm Hg. The MK leaked at higher pressure than all other knots, including the LMK ( P < .001). The LMK leaked at greater pressures compared with the Sx and the LSx ( P < .001). No difference was detected between leaking pressures of the Sx and the LSx ( P = .226), with both leaking at pressures below 40 mm Hg. Conclusion The LMK created a more secure first throw compared with the Sx and leaked at supraphysiologic pressures. Clinical significance The LMK has excellent knot holding strength on a vascular pedicle model and may be further evaluated for clinical application.