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A laparoscopic knot-tying device for minimally invasive cardiac surgery

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A laparoscopic knot-tying device for minimally invasive cardiac surgery

Auteurs : Shaphan R. Jernigan [États-Unis] ; Guillaume Chanoit [États-Unis] ; Arun Veeramani [États-Unis] ; Stephen B. Owen [États-Unis] ; Matthew Hilliard [États-Unis] ; Denis Cormier [États-Unis] ; Bryan Laffitte [États-Unis] ; Gregory Buckner [États-Unis]

Source :

European journal of cardio-thoracic surgery [ 1010-7940 ] ; 2010.

RBID : Pascal:10-0205172

Descripteurs français

Pascal (Inist)
- Laparoscopie, Dispositif, Chirurgie miniinvasive, Coeur, Fixation, Appareil circulatoire, Cardiologie, Pneumologie.

English descriptors

KwdEn :
- Cardiology, Circulatory system, Device, Fixation, Heart, Laparoscopy, Minimally invasive surgery, Pneumology.

Abstract

Objective: Intracorporeal suturing and knot tying can complicate, prolong or preclude minimally invasive surgical procedures, reducing their advantages over conventional approaches. An automated knot-tying device has been developed to speed suture fixation during minimally invasive cardiac surgery while retaining the desirable characteristics of conventional hand-tied surgeon's knots: holding strength and visual and haptic feedback. A rotating slotted disc (at the instrument's distal end) automates overhand throws, thereby eliminating the need to manually pass one suture end through a loop in the opposing end. The electronic actuation of this disc produces left or right overhand knots as desired by the operator. Methods: To evaluate the effectiveness of this technology, seven surgeons with varying laparoscopic experience tied knots within a simulated minimally invasive setting, using both the automated knot-tying tool and conventional laparoscopic tools. Suture types were 2/0 braided and 4/0 monofilament. Results: Mean knot-tying times were 246 ± 116 s and 102 ± 46 s for conventional and automated methods, respectively, showing an average 56% reduction in time per surgeon (p = 0.003, paired t-test). The peak holding strength of each knot (the force required to break the suture or loosen the knot) was measured using tensile-testing equipment. These peak holding strengths were normalised by the ultimate tensile strength of each suture type (57.5 N and 22.1 N for 2/0 braided and 4/0 monofilament, respectively). Mean normalised holding strengths for all knots were 68.2% and 71.8% of ultimate tensile strength for conventional and automated methods, respectively (p = 0.914, paired t-test). Conclusions: Experimental data reveal that the automated suturing device has great potential for advancing minimally invasive surgery: it significantly reduced knot-tying times while providing equivalent or greater holding strength than conventionally tied knots.

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Le document en format XML

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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cardiology</term>
<term>Circulatory system</term>
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<term>Laparoscopy</term>
<term>Minimally invasive surgery</term>
<term>Pneumology</term>
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<keywords scheme="Pascal" xml:lang="fr"><term>Laparoscopie</term>
<term>Dispositif</term>
<term>Chirurgie miniinvasive</term>
<term>Coeur</term>
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<front><div type="abstract" xml:lang="en">Objective: Intracorporeal suturing and knot tying can complicate, prolong or preclude minimally invasive surgical procedures, reducing their advantages over conventional approaches. An automated knot-tying device has been developed to speed suture fixation during minimally invasive cardiac surgery while retaining the desirable characteristics of conventional hand-tied surgeon's knots: holding strength and visual and haptic feedback. A rotating slotted disc (at the instrument's distal end) automates overhand throws, thereby eliminating the need to manually pass one suture end through a loop in the opposing end. The electronic actuation of this disc produces left or right overhand knots as desired by the operator. Methods: To evaluate the effectiveness of this technology, seven surgeons with varying laparoscopic experience tied knots within a simulated minimally invasive setting, using both the automated knot-tying tool and conventional laparoscopic tools. Suture types were 2/0 braided and 4/0 monofilament. Results: Mean knot-tying times were 246 ± 116 s and 102 ± 46 s for conventional and automated methods, respectively, showing an average 56% reduction in time per surgeon (p = 0.003, paired t-test). The peak holding strength of each knot (the force required to break the suture or loosen the knot) was measured using tensile-testing equipment. These peak holding strengths were normalised by the ultimate tensile strength of each suture type (57.5 N and 22.1 N for 2/0 braided and 4/0 monofilament, respectively). Mean normalised holding strengths for all knots were 68.2% and 71.8% of ultimate tensile strength for conventional and automated methods, respectively (p = 0.914, paired t-test). Conclusions: Experimental data reveal that the automated suturing device has great potential for advancing minimally invasive surgery: it significantly reduced knot-tying times while providing equivalent or greater holding strength than conventionally tied knots.</div>
</front>
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A laparoscopic knot-tying device for minimally invasive cardiac surgery

A laparoscopic knot-tying device for minimally invasive cardiac surgery

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Descripteurs français

English descriptors

Abstract

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