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ROEDER'S KNOT

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aimen syed

on 23 November 2012

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Transcript of ROEDER'S KNOT

ROEDER'S KNOT HISTORY
A knot used primarily in laparoscopic surgery. Patented by Hans Albert Röder in  1931  along with a knot applicator who used it for tonsilectomy .
INTRODUCTION
Laparoscopy is useful to treat surgical diseases, yet tying sutures in the cavity is challenging and very frustrating as movement and visibility is in 2 dimensions ,fulcrum of movement is away from the the site ,the surgeon is unable to use the twist movement at wrist joint, limited space and limited visibility . A knot to secure tissue approximation, which would be hand-made, secure, simple, easy, quick, reliable, and extracorporeal without extra mechanical devices .
HOW TO MAKE ?

1. Make one short limb (the post) and one long limb (the loop)
2. Throw the loop... 3. ... around the post 4. Next throw the loop around both
limbs.
6. Pass the tail of the loop limb between the second and third loop.
5. Throw the loop only around the post limb.
7. The knot is tensioned and pushed into the joint with a knot pusher on the post limb.

8 & 9. The knot is secured with a series of half hitches, thrown in alternate directions.
HOW TO INSERT? ligature security of commercially available pre-tied ligatures versus hand tied ligatures Commercially available Endoloop and 4 hand-tied slipknot ligatures were compared with a 4-layer square knot. The hand tied ligature knots tested were the 4S modified Roeder knot, the Brooks knot, the modified Roeder knot, and the Weston knot.
RESULTS:
Only the 4S modified Roeder knot in 2 polydioxanone (103 N) was comparable with the breaking strength of the square knots (157 N). All other knot suture combinations tested were significantly weaker than the square knot (range, 2-18 N).
CONCLUSION:
For equine laparoscopy, a 2 polydioxanone 4S modified Roeder knot would be an acceptable alternative to the commercially available Endoloop.
MODIFICATIONS
4S modification : It is tied by adding a fourth wrap around the suture loop and securing the loop in
place with a square knot rather than a single half-hitch.
Experience : We have used this knot in laparoscopic surgeries for more than 2 years and have not observed knot slippage.
Conclusion: This modification results in a knot comparable in strength to the strongest laparoscopic multiple-throw square knots.
The 4S-modified Roeder was significantly and consistently stronger than the other slipknots. Polyglyconate was superior to other suture materials. The 1 polyglyconate had the highest mean peak force to failure followed by 0 polyglyconate that exceeded the 1PDS.
CLINICAL RELEVANCE:
The 4S-modified Roeder slipknot using 1 polyglyconate has the greatest breaking strength of sutures tested and should be considered when performing laparoscopic ligatures.
Comparison of the performance of the Gea extracorporeal knot with the Roeder extracorporeal knot and the classical knot.
RESULTS:
The Gea knot was significantly faster statistically to perform than the Roeder knot and more resistant against rupture and slippage. The slippage rate was significantly lower statistically in the Gea knot than in the Roeder knot when Polyglactin 910 and polypropylene were used.
SIGNIFICANCE
1) COMPARISION WITH ENDOLOOP
As compared to endoloop which is comercially available pretied knots Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups in a study 2) APPLICATIONS DIFFERENT IN SURGICAL PROCEDURES
> to ligate larger vessels during dissection
used routinely, in our practice to ligate the cystic duct during laparoscopic Cholecystectomy.
>appendectomy
>The Roeder knot with 3 RHAPs provides the best balance of loop security and knot security within the sliding knot configurations tested in this study regardless of suture type.( Arthroscopic knots: determining the optimal balance of loop security and knot security).
>Hernial sac
>Tubal ligation for ectopic pregnancies
KNOT SECURITY
The 4S modified Roeder, modified Roeder, and Weston and Brooks laparoscopic slipknots using 0 polyglyconate, 0 polyglycolic acid, 1 polyglyconate, and 1 polydioxanone (PDS) were tested. A vertical distracting force (5 mm/s) was applied until failure. Mean peak force to failure was obtained for each suture material, size, and knot combination.
RESULTS:
Mean (+/-SEM) peak force to failure of hand-tied ligatures ranged from 156.8+/-9.1 N to 4.8+/-.4 N. The 4S-modified Roeder had the highest mean peak force to failure. Ligatures tied with polyglyconate and size 1 suture had the highest mean peak force to failure.
CONCLUSIONS:
The 4S-modified Roeder was significantly and consistently stronger than the other slipknots. Polyglyconate was superior to other suture materials. The 1 polyglyconate had the highest mean peak force to failure followed by 0 polyglyconate that exceeded the 1PDS.
CLINICAL RELEVANCE:
The 4S-modified Roeder slipknot using 1 polyglyconate has the greatest breaking strength of sutures tested and should be considered when performing laparoscopic ligatures.
4) COST EFFECTIVENESS (the BIG factor)
The average price of material used for closing the base of appendix was 81 American Dollars (USD) for laparoscopic appendectomy with endoloop, and 8 USD for the technique described by this article. Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups.
References
↑ Roeder HA. Chirurgischer Faden. Patent #566173, Deutches Reich Reichspatentamt, Berlin, Germany. Published March 16, 1933. Available from http://depatisnet.dpma.de - search for document DE 566173A
↑ Hage JJ. On the origin and evolution of the Roeder knot and loop--a geometrical review. Surgical laparoscopy, endoscopy & percutaneous techniques. 2008 Feb; 18(1):1-7.(Link to article – subscription may be required.) SYEDA AIMEN
"RMC" THANK YOU
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