Comparative strength of ligature points achieved by various surgical knot-tying techniques: an observational study using Maxon™ monofilament sutures

Shoichi Tsuzaka; Yuji Konishi; Kazuhiro Mino; Naotake Honma; Hideki Kawamura; Takuto Yoshida; Akinobu Taketomi

doi:10.1007/s00595-024-02936-5

Comparative strength of ligature points achieved by various surgical knot-tying techniques: an observational study using Maxon™ monofilament sutures

Surg Today. 2024 Sep 28. doi: 10.1007/s00595-024-02936-5. Online ahead of print.

Authors

Shoichi Tsuzaka¹, Yuji Konishi², Kazuhiro Mino¹, Naotake Honma³, Hideki Kawamura¹, Takuto Yoshida⁴, Akinobu Taketomi⁵

Affiliations

¹ Department of Surgery, National Hospital Organization Hokkaido Medical Center, 1-1, 5-7, Yamanote, Nishi-Ku, Sapporo, Hokkaido, 063-0005, Japan.
² Department of Surgery, National Hospital Organization Hokkaido Medical Center, 1-1, 5-7, Yamanote, Nishi-Ku, Sapporo, Hokkaido, 063-0005, Japan. blue-ocean@outlook.jp.
³ Department of Thoracic Surgery, National Hospital Organization Hokkaido Medical Center, 1-1, 5-7, Yamanote, Nishi-Ku, Sapporo, Hokkaido, 063-0005, Japan.
⁴ Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada.
⁵ Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-Ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan.

PMID: 39340663
DOI: 10.1007/s00595-024-02936-5

Abstract

Purpose: Surgical knot-tying requires careful selection of the appropriate technique for optimal outcomes; however, evidence is lacking about the common ligation techniques combining square and slip knots (combination knots). This study investigates the strength of a combination knot, compared with other techniques.

Methods: In this observational cohort study, we assessed the strengths of square, slip-granny, slip-reef, and combination knots using absorbable monofilament sutures, and compared them using ANOVA and a multilevel linear regression analysis. We also assessed the correlation between the number of throws and knot strength using Spearman's correlation analysis.

Results: Among 80 ligatures, ANOVA indicated significant differences in knot strength among the techniques (p < 0.01). Multilevel linear regression showed that a combination knot was stronger than a slip knot (p < 0.01) and comparable to a square knot (p = 0.0721). Secondary analysis indicated that for combination knots, five throws could achieve sufficient knot strength.

Conclusion: Combination knots are as strong as square knots and stronger than slip knots, and thus present a reasonable option for surgical ligation.

Keywords: Ligation; Sliding knot; Slip knot; Square knot; Suture technique.