Knot-Tying for the Thoracoscopic Surgeon

Thoracoscopic surgery has usually been limited by 2-dimensional vision and the limited space between ribs—problems that have been only partially overcome by the use of ro-botics. One of the technical challenges of any minimally invasive surgical approach is tying an intracorporeal knot. For the thoracoscopic surgeon, we describe an easier technique of knot-tying that involves using a right-angled dissector. The technique enables ambi-dextrous performance and is particularly useful for ligating major pulmonary vessels that might be too small to be stapled or too confined for the admission and maneuvering of a stapling device. Rotating the thumb-dials accordingly enables one to vary the configura-tion of the knots to create slip or reef knots. The technique is easy to learn and does not require any complicated devices. It is easily adapted to create even more complex constructs, such as a double surgeon’s knot. This technique has special advantages in areas of limited domain and in situations that require very narrow angles of instrument manipulation, particularly in thoracoscopic-assisted pro-cedures. (Tex Heart Inst J 2010;37(4):435-8) T he last decade has seen significant advances in the development of instrumen-tation for thoracoscopic and robotic surgery. There is no question that most practitioners of minimally invasive surgery rely heavily on special instrument