A Remarkably Easy Knot-Tying Technique for Single-Incision Laparoscopic Surgery with the SILS Port for Gynecologic Diseases
A Remarkably Easy Knot-Tying Technique for Single-Incision Laparoscopic Surgery with the SILS Port for Gynecologic Diseases
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DOI：
10.1016/j.jmig.2011.03.014
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发表时间：
2011-07-01
影响因子：
4.1
通讯作者：
Saito, Tsuyoshi
中科院分区：
文献类型：
--
作者：
Endo, Toshiaki;Nagasawa, Kunihiko;Saito, Tsuyoshi
单切口腹腔镜手术（锡尔斯）已被迅速接受，特别是对于女性，因为美容效益可能大于普通腹腔镜手术。在妇科疾病中，锡尔斯适用于诊断性腹腔镜检查、卵巢切除术和输卵管切除术等。此外，在锡尔斯过程中，用于内包封的打结过程是主要的限速步骤，也是锡尔斯普及的关键决定因素。尽管旋转器器械可用于创建所需的手术角度，但打结仍然被认为是困难的。我们设计了一种非常简单的打结技术，可在SILS期间使用带有旋转器和直型针驱动器的锡尔斯端口进行打结。我们确定，在穿入针后，应相对于Roticulator头端的长轴（以80度铰接）以约90度的角度抓住线的长尾。由于引力的作用，这会自动形成一个理想的C环。与长尾连接的针应面向Roticulator头端的远端侧（从外科医生的角度）。然后，C形环的顶点从Roticulator头端朝向近端侧（从外科医生的角度）。该线位置在打结过程中很重要。然后，通过对针驱动器的杆施加一系列轴向旋转运动，将C形环的上臂固定。此时，针驱动器的钳口应保持打开状态，以免线从棒上滑落。这种技术的好处是它不需要任何特殊技能;任何能够进行颅内手术的外科医生也应该能够在锡尔斯期间轻松打结。微创妇科学杂志（2011）18，500-502（C）2011 AAGL。All rights reserved.
Single-incision laparoscopic surgery (SILS) has been quickly accepted, especially for women, because the cosmetic benefits may be greater than with ordinary laparoscopic surgery. In gynecologic disease, SILS is appropriate for diagnostic laparoscopy, oophorectomy, and salpingectomy, among other conditions. In addition, the knot-tying process for intracorporeal suturing during SILS is a major rate-limiting step and a key determinant of the popularity of SILS. Although a roticulator instrument is useful for creating the needed operative angle, knot tying is still believed to be difficult. We have devised a remarkably simple knot-tying technique that can be applied during SILS with a SILS Port with a Roticulator and a straight-type needle driver. We determined that, after transfixing the needle, the long tail of the thread should be grasped at around 90 degrees relative to the long axis of tip of the Roticulator, which is articulated at 80 degrees. This automatically forms an ideal C-loop because of gravitation. The needle attached to the long tail should face the distal side from the tip of Roticulator (from the surgeon's perspective). The apex of the C-loop is then toward the proximal side from the tip of the Roticulator (from the perspective of the surgeon). This thread position is important during the knot-tying process. The upper arm of the C-loop should then be entwined by applying a series of axial spinning movements to the rod of the needle driver. At this time, the jaws of the needle driver should be kept open so the thread does not slip off of the rod. The benefit of this technique is that it does not require any special skills; any surgeon able to perform intracorporeal suturing should also be able to easily tie knots during SILS. Journal of Minimally Invasive Gynecology (2011) 18, 500-502 (C) 2011 AAGL. All rights reserved.