These methods utilising the Mertie Needle Holder are unique and
demystify the techniques of endoscopic knot tying.
The following diagrams display three applications of the method:
- Instrument Method
- Innovative instrument method (hand tie technique)
- Combination method
1. Instrument Method
Diagram 5 Open surgical method
- Configuration of a C formation on the bight with the R instrument.
- L clockwise rotation and advance to form the reverse directed
loop on the suture.
- L grasps the tail, rotated anticlockwise and withdrawn.
- The first halfhitch.
- L transferred and holds the suture in a C loop configuration.
R released from bight and the jaw is closed.
Next anticlockwise rotation of R around the suture forms the second
reverse loop on the bight.
- R grasps the tail.
- R rotates clockwise and withdraws the tail.
- Completed square knot. Instrument
separation tightens the knot.
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2. Innovative instrument method
Diagram 6 Hand tie method, performed with instruments
- R holds tail, L holds the bight.
- R anti-clockwise rotation over the bight, the spur captures
the suture to form a
loop under the bight. Clockwise rotation of L can assist this
loop formation.
- Further R anti-clockwise rotation under bight and through the
loop. A double loop,
sugical half hitch can easily be formed by further rotation of
R around the bight.
L transfers to grasp the tail.
- Release suture tail from R, close R jaw then clockwise rotation
and withdrawal.
- R grasps bight, separation of R and L tightens the half hitch.
- anticlockwise rotation of R forms a loop on the bight, clockwise
rotation of L over
bight and advance through the loop. The spur
appendage can assist with this loop formation.
Next (not shown) R transfers to grasp tail. Repeat fig. (d) and
(e) with the opposite instruments
to complete and tighten the square knot. Further half hitch loops
can be performed as needed.
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3. Combination Method
Diagram 7 Combination of Instrument and Hand tie methods
Only one instrument interchange needed.
- L holds bight in C formation.
- R orbital clockwise rotation under the bight forms a reverse
loop. or
- Two or more loops.
- R grasps tail, then followed by clockwise rotation and withdrawal
of R.
- First half hitch formed, instrument separation tightens the
hitch.
Specific instrument movements, as in open surgery, can create
suture
locking techniques if needed.
- R anti-clockwise rotation over, then forward and under the bight
creates a
forward loop. The spur can assist with this loop formation, as
does
clockwise rotation of L.
- L transfered to tail, release R, close jaw and clockwise rotational
withdrawal of R.
- R grasps bight, instrument separation
tightens the square knot.
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