BMJ Surgery Interventions Health Technologies最新文献

{"title":"How much is enough? Finding the minimum annual surgical volume threshold for total knee replacement.","authors":"Per-Henrik Randsborg, Amanda C Chen","doi":"10.1136/bmjsit-2021-000092","DOIUrl":"10.1136/bmjsit-2021-000092","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000092"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/33/bmjsit-2021-000092.PMC8647569.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39838722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How much is enough for total knee arthroplasty?","authors":"Caesar Wek, Tosan Okoro, Sebastian Tomescu, J Michael Paterson, Bheeshma Ravi","doi":"10.1136/bmjsit-2021-000102","DOIUrl":"10.1136/bmjsit-2021-000102","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000102"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/b0/bmjsit-2021-000102.PMC8647575.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39838727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework.","authors":"Takeaki Ishizawa,&nbsp;Peter McCulloch,&nbsp;Derek Muehrcke,&nbsp;Thomas Carus,&nbsp;Ory Wiesel,&nbsp;Giovanni Dapri,&nbsp;Sylke Schneider-Koriath,&nbsp;Steven D Wexner,&nbsp;Mahmoud Abu-Gazala,&nbsp;Luigi Boni,&nbsp;Elisa Cassinotti,&nbsp;Charles Sabbagh,&nbsp;Ronan Cahill,&nbsp;Frederic Ris,&nbsp;Michele Carvello,&nbsp;Antonino Spinelli,&nbsp;Eric Vibert,&nbsp;Muga Terasawa,&nbsp;Mikiya Takao,&nbsp;Kiyoshi Hasegawa,&nbsp;Rutger M Schols,&nbsp;Tim Pruimboom,&nbsp;Yasuo Murai,&nbsp;Fumihiro Matano,&nbsp;Michael Bouvet,&nbsp;Michele Diana,&nbsp;Norihiro Kokudo,&nbsp;Fernando Dip,&nbsp;Kevin White,&nbsp;Raul J Rosenthal","doi":"10.1136/bmjsit-2021-000088","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000088","url":null,"abstract":"<p><strong>Objectives: </strong>Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures.</p><p><strong>Design: </strong>Narrative literature review with analysis of IDEAL stage of each field of study.</p><p><strong>Setting: </strong>All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery.</p><p><strong>Main outcome measures: </strong>The IDEAL stage of research evidence was determined for each specialty field using a previously described approach.</p><p><strong>Results: </strong>196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported.</p><p><strong>Conclusions: </strong>Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000088"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/50/bmjsit-2021-000088.PMC8749280.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the training program for Versius, a new innovative robotic system for use in minimal access surgery.","authors":"Jessica Butterworth,&nbsp;Margaux Sadry,&nbsp;Danielle Julian,&nbsp;Fiona Haig","doi":"10.1136/bmjsit-2020-000057","DOIUrl":"https://doi.org/10.1136/bmjsit-2020-000057","url":null,"abstract":"<p><strong>Objectives: </strong>The Versius surgical system has been developed for use in robot-assisted minimal access surgery (MAS). This study aimed to evaluate the effectiveness of the Versius training program.</p><p><strong>Design: </strong>A 3.5-day program following 10 hours of online didactic training. Participants were assessed during the technical training using the Global Evaluative Assessment of Robotic Skills (GEARS).</p><p><strong>Setting: </strong>Dry box exercises were conducted in classrooms, and wet lab sessions simulated an operating room environment using cadaveric specimens.</p><p><strong>Participants: </strong>Seventeen surgical teams participated; surgeons represented general, colorectal, obstetrics/gynecology, and urology specialties. All surgeons had previous laparoscopic MAS experience, while experience with robotics varied.</p><p><strong>Main outcomes measures: </strong>Participants were scored on a five-point Likert Scale for each of six validated GEARS domains (depth perception, bimanual dexterity, efficiency, force sensitivity, autonomy, and robotic control). Additional metrics used to chart surgeon performance included: combined instrument path length; combined instrument angular path; and time taken to complete each task.</p><p><strong>Results: </strong>Participants demonstrated an overall improvement in performance during the study, with a mean GEARS Score of 21.0 (SD: 1.9) in Assessment 1 increasing to 23.4 (SD: 2.9) in Validation. Greatest improvements were observed in the depth perception and robotic control domains. Greatest differences were observed when stratifying by robotic experience; those with extensive experience consistently scored higher than those with some or no experience.</p><p><strong>Conclusions: </strong>The Versius training program is effective; participants were able to successfully operate the system by program completion, and more surgeons achieved intermediate-level and expert-level GEARS scores in Validation compared with Assessment 1.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000057"},"PeriodicalIF":0.0,"publicationDate":"2021-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/1b/bmjsit-2020-000057.PMC8647592.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39838725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Rise of the Machines': Human Factors and training for robotic-assisted surgery.","authors":"Fiona Kerray,&nbsp;Steven Yule","doi":"10.1136/bmjsit-2021-000100","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000100","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. Surgery is perpetually at the cutting edge of innovation. And like in other innovative industries, the rate of uptake of new technology often outstrips comprehensive understanding of the systems changes and safety implications encountered. Roboticassisted surgery (RAS) presents potential benefits to patients, including shorter hospital stays, reduced postoperative pain, and quicker recovery time. However, patient safety incidents may be as high as double compared with traditional open surgery, revealing the cost of new technology integration, and reminiscent of the rise of laparoscopic surgery in the early 1990s. Along with a supportive culture and effective systems, highquality training is one of the foundations of successful technology adoption. In the present issue of BMJ Surgery, Interventions & Health Technologies, Butterworth et al present an indepth training programme for roboticassisted surgery, focusing on one specific surgical robot. The authors have developed what appears to be a comprehensive hybrid training programme, combining online education followed by facetoface simulations and cadaver sessions with real surgical teams. This study provides initial validity evidence which is important for technology implementation with the ultimate aim to have a training programme that equips surgeons to expertly embed robotic surgery within their practice. The aim of our editorial is to provide a helpful critique regarding validity, and introduce the role of Human Factors to the successful implementation and evaluation of RAS training. Like many applied studies of this type there are some conceptual and methodological limitations which limit the validity of findings and also broadly applicable to surgical education research. Butterworth et al aimed to evaluate the effectiveness of the training programme, however without defined standards it is unclear whether the training was aimed at improving surgeons’ technical ability or whether it was to train them to proficiency. Implementing a validity framework such as Kirkpatrick’s can be invaluable in this respect, as it allows researchers to evaluate both formal and informal training methods against four levels of criteria: reactions (did the training meet surgeons’ needs?), learning (has knowledge or skill increased?), behaviour (can surgeons now apply robotic surgical skills in real life?), and results (has training improved outcomes and safety?). By applying Kirkpatrick’s lens to the present study, we can say that the highest level of validity is at level 2: learning; as there is some evidence of participant skill improving. However, 2 of the 17 surgeons moved from intermediate to novice level which means that the training was not universally successful and may even have been counterproductive. Heterogeneity in prior experience of surgery and robotics of partici","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000100"},"PeriodicalIF":0.0,"publicationDate":"2021-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/ea/bmjsit-2021-000100.PMC8647617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39699148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: “Rise of the machines”: human factors and training for robotic-assisted surgery","authors":"Jane R. Butterworth, Margaux Sadry, Danielle Julian, Fiona Haig","doi":"10.1136/bmjsit-2021-000115","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000115","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. We thank Kerray and Yule for their Editorial on our evaluation of a training program developed specifically for Versius, a nextgeneration system for robotassisted minimal access surgery (MAS). We have found the points raised, particularly those pertaining to validity frameworks and human factors, to be constructive, providing valuable guidance for future studies evaluating the effectiveness of trainings in the surgical setting. The program we described is intended to provide surgeons with practical experience operating the system in a simulated environment and is not focused on a specific surgical specialty or procedure. As such, the aim of the study was to monitor performance using the system as surgeons became more familiar and practiced using the system over the course of the program. The use of Global Evaluative Assessment of Robotic Skills (GEARS) scoring provided a validated means of quantifying performance across a range of tasks to allow comparison between surgeon subgroups and timepoints. The proficiency levels were determined from the literature only to help contextualize GEARS scores, not to ascertain operating proficiency for individual surgeons using the system. The features of the device noted in the study publication provide specific examples of how aspects of the design may help remove some of the barriers to uptake of MAS by minimizing the limitations often associated with conventional MAS instruments. Increasing uptake of MAS by incorporating robotic assistance to help improve patient outcomes compared with open surgery was the fundamental driver behind the device’s conception and development; the advantages of MAS over open surgery are numerous and well established, yet MAS utilization has been lower than anticipated hitherto across several common procedures. Cooper et al also note that lack of specific training and exposure to MAS techniques may be partly attributable to the low uptake. We anticipate that purposedesigned training programs such as this one will play an important role in realizing the vast potential of robotic systems as the field evolves. While implementation of Kirkpatrick’s validity framework could have informed the study design to help better address criteria within levels 1 and 3, level 4, assessing the impact of the training on surgical outcomes and safety, was not within the scope of this study as this is only possible in the clinical setting. Ongoing systematic collection of clinical effectiveness and safety data into a purpose designed registry will facilitate longerterm monitoring and largescale analyses of outcomes, in line with IDEALD recommendations. As noted by Kerray and Yule, surgeons with experience using other robotic systems may require more training to adjust to a new platform compared with surgeons with no prior robotics experience. As this surgical syste","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46608767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cohort study of impact on length of stay of individual enhanced recovery after surgery protocol components.","authors":"Rachel C Sisodia,&nbsp;Dan Ellis,&nbsp;Michael Hidrue,&nbsp;Pamela Linov,&nbsp;Elena Cavallo,&nbsp;Allison S Bryant,&nbsp;May Wakamatsu,&nbsp;Marcela G Del Carmen","doi":"10.1136/bmjsit-2021-000087","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000087","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery.</p><p><strong>Design: </strong>A cohort study.</p><p><strong>Setting: </strong>Large tertiary academic medical centre.</p><p><strong>Participants: </strong>The study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063).</p><p><strong>Intervention: </strong>The addition of ERAS to perioperative care.This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated.</p><p><strong>Main outcome measures: </strong>Impact of ERAS process measure adherence on length of stay.</p><p><strong>Results: </strong>After initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (-30%, 95% CI -18% to 40%) and decreased postoperative fluid administration (-12%, 95% CI -1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (-53%, 95% CI -55% to 52%).</p><p><strong>Conclusions: </strong>While adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000087"},"PeriodicalIF":0.0,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/52/4b/bmjsit-2021-000087.PMC8749327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39834980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint effort: a call for standardization in total joint arthroplasty data reporting.","authors":"Alexander Y Liebeskind,&nbsp;Marc Nieuwenhuijse,&nbsp;Jensen H Hyde,&nbsp;Amanda C Chen,&nbsp;Suvekshya Aryal,&nbsp;Per-Henrik Randsborg","doi":"10.1136/bmjsit-2021-000079","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000079","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000079"},"PeriodicalIF":0.0,"publicationDate":"2021-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/8e/bmjsit-2021-000079.PMC8647589.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39834978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Call for emergency action to limit global temperature increases, restore biodiversity and protect health.","authors":"Lukoye Atwoli,&nbsp;Abdullah H Baqui,&nbsp;Thomas Benfield,&nbsp;Raffaella Bosurgi,&nbsp;Fiona Godlee,&nbsp;Stephen Hancocks,&nbsp;Richard Horton,&nbsp;Laurie Laybourn-Langton,&nbsp;Carlos Augusto Monteiro,&nbsp;Ian Norman,&nbsp;Kirsten Patrick,&nbsp;Nigel Praities,&nbsp;Marcel Gm Olde Rikkert,&nbsp;Eric J Rubin,&nbsp;Peush Sahni,&nbsp;Richard Smith,&nbsp;Nicholas J Talley,&nbsp;Sue Turale,&nbsp;Damián Vázquez","doi":"10.1136/bmjsit-2021-000112","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000112","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000112"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to tie dangerous surgical knots: easily. Can we avoid this?","authors":"Eric Drabble,&nbsp;Sofia Spanopoulou,&nbsp;Eleni Sioka,&nbsp;Ellie Politaki,&nbsp;Ismini Paraskeva,&nbsp;Effrosyni Palla,&nbsp;Lauren Stockley,&nbsp;Dimitris Zacharoulis","doi":"10.1136/bmjsit-2021-000091","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000091","url":null,"abstract":"<p><strong>Objective: </strong>Secure knots are essential in all areas of surgical, medical and veterinary practice. Our hypothesis was that technique of formation of each layer of a surgical knot was important to its security.</p><p><strong>Design: </strong>Equal numbers of knots were tied, by each of three groups, using three techniques, for each of four suture materials; a standard flat reef knot (FRK), knots tied under tension (TK) and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and tested by distraction with increasing force, till each material broke or the knot separated completely.</p><p><strong>Setting: </strong>Temporary knot tying laboratory.</p><p><strong>Materials: </strong>The suture materials were, 2/0 polyglactin 910 (Vicryl), 3/0 polydioxanone, 4/0 poliglecaprone 25 (Monocryl) and 1 nylon (Ethilon).</p><p><strong>Participants: </strong>Three groups comprised, a senior surgeon, a resident surgeon and three medical students.</p><p><strong>Outcome measures: </strong>Proportion of each knot type that slipped, degree of slippage and length of suture held in loop secured by each knot type.</p><p><strong>Results: </strong>20% of FRK tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip was significantly less for FRK (mean 6.3%-, 95% CI 2.2% to 10.4%) than for TK (mean 312%, 95% CI 280.0% to 344.0%) and NHCK (mean 113.0%, -95% CI 94.3% to 131.0%).The mean length of suture in loops held within (FRK mean 25.1 mm 95% CI 24.2 to 26.0 mm) was significantly greater than mean lengths held by the other techniques (TK mean 17.0 mm, 95% CI 16.3 to 17.7 mm), (NHCK mean 16.3 mm, 95% CI 15.9 to 16.7 mm). The latter two types of knot may have tightened more than anticipated, in comparison to FRK, with potential undue tissue tension.</p><p><strong>Conclusion: </strong>Meticulous technique of knot tying is essential for secure knots, appropriate tissue tension and the security of anastomoses and haemostasis effected.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000091"},"PeriodicalIF":0.0,"publicationDate":"2021-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjsit-2021-000091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}