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  • Title: Laparoscopic knot substitutes. An assessment of techniques of securing sutures through the laparoscope.
    Author: Andrews SM, Lewis JL.
    Journal: Endosc Surg Allied Technol; 1994 Feb; 2(1):62-5. PubMed ID: 8081918.
    Abstract:
    Advanced interventional laparoscopy has required the development of new methods of securing sutures as alternatives to the three-throw reef knot. A tensiometer was designed to measure the forces required for distraction of various knots or securing devices with different sutures. A three-throw reef knot was used as a control. Each device was tested 15 times, and the tension at which the "knot" slipped was recorded. Titanium clips (Ligaclip, Ethicon), locking polydioxanone clips (Absolok and Lapra-ty, Ethicon), malleable collars, Roeder knots and biocompatible glue (Histoacryl, B Braun Melsungen AG) were all assessed. Sutures secured with Ligaclips, Absolok clips and glue were significantly weaker than the three-throw reef knot. Sutures secured with malleable collars and Lapra-ty clips were as strong as the three-throw reef knot and have potential for use as knot substitutes.
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