Interrupted Suture
The goal of this exercise is to create a single interrupted Z- or U-stitch using a group of four marked circles. The stitch must be tied with at least three knots to complete the task.
Any group of four circles can be used.
Suture...
A 5/0 Prolene stitch with a 17 mm 1/2 round needle is recommended. Both single and dual-needle options can be used in this exercise..
Introduction
The main focus of this exercise is to develop the ability to reliably tie sutures during a VATS procedure.
Knot pusher
In VATS, unlike laparoscopic surgery, tying the knot intracorporeally is usually not very convenient due to the lack of proper instrument triangulation.
Knot tying in VATS is typically performed using a knot pusher. However, when the target is located very close to the utility incision, the knot can also be pushed inside directly using the index finger.
Knot pusher...
VATS knot pushers are introduced through the utility port and can, therefore, be shorter with a tip-heavy design to simplify the knot-pushing process.
Pushing the knot
A single knot is created outside the chest cavity. Both free ends of the suture are then held, typically in the non-dominant hand, ensuring one end is kept taut while the other remains slightly loose to facilitate smooth sliding of the knot.
There are several ways to hold the free ends of the suture:
- Rolling. One end of the suture can be rolled around the index finger several times and held taut, while the other end is pinched between the tips of the index finger and thumb.
- Weaving. Alternatively, one free end can be weaved between the index, middle, and ring fingers, offering a secure grip while maintaining the required tension.
- Clamps. Some surgeons attach small pean clamps to both ends of the suture, using their weight to provide the necessary tension.
A knot pusher is engaged on the knot and used to push it into the chest cavity.
The knot pusher should not be pushed all the way to the structure being sutured. Instead, by advancing it slightly beyond the structure, the surgeon ensures the knot is securely tightened, optimally positioned, and applied without undue tension or tissue damage.
- Prevent Loose Knot. Advancing the knot pusher slightly beyond the structure fully tightens the knot against the tissue, ensuring it is clean, tight, and properly positioned.
- Prevent Damage. Pressing the knot pusher directly onto the structure may exert excessive pressure, potentially causing trauma to delicate tissues, such as vessels.