Features of the “twitching technique”-A new laparoscopic ligation technique

Abstract

Background: Laparoscopic intracorporeal sutures and knots require advanced techniques in children. We previously reported a new ligation technique named the twitching technique (TT) using a revolvable needle holder. To evaluate the efficacy of TT, we performed laparoscopic training and thereafter held a knot tying exam for medical students. Methods: We performed 120 min laparoscopy training in 53 medical students (4th or 5th year) at Hiroshima University following a knot tying examination of C-loop and TT under normal and narrow angle situations. Results: In total, 53 students were examined. The numbers of laparoscopic knot tying successes by C-loop and TT were 5.5 vs. 4.0 under normal-angle and 4.6 vs. 3.7 under narrow-angle conditions. The numbers of laparoscopic knot tying failures by C-loop and TT were 5.7 vs. 0.2 (p < 0.01) under normal-angle and 3.9 vs. 0.1 (p<0.01) under narrow-angle conditions. The frequencies of table movement and disappearance of forceps from the screen were also higher in knot tying with C-loop than with the TT. Conclusions: The TT is an easy to learn, and a steady and safe method of ligation for difficult situations. This method may facilitate the performance of many laparoscopic surgeries in pediatric fields. Level of evidence: Ⅳ

Keywords

• Laparoscopic surgery
• Intracorporeal ligation
• Pediatric surgery
• Minimal invasive surgery