Points, lines, and a plane in 3-dimensions to understand the tying of an easy laparoscopic knot

Abstract

  In a laparoscopic surgery, direct visibility is low and the movements of the forceps are restricted. Hence, tying a laparoscopic knot, especially an intracorporeal knot, is a challenging task. Mastering the intracorporeal knot should be a skill to be mastered by any laparoscopist. Some of the technical limitations in mastering this method are: a restricted range of manipulation of the instrument through the port placement sites, a narrow operative field, and a difficult visualization along with a decreased 3-dimensional spatial understanding while tying the knot. Two new methods of tying the knot namely "Pointing method" and "Swing method" are presented here. In these methods, the series of movements of the tip of an instrument are analyzed in a given dimension. In the Pointing method, the tip of the instrument in the dominant hand moves to and fro along a hypothetical line, which is drawn between a port placement site of the dominant hand and the point where the knot will be placed. In the Swing method, the tips of the instruments in both hands are swung from right to left along the surface of an imaginary plane that contains the two port placement sites and the knotting point in a line. In both these methods, the movement of the tips of the instruments is reduced from 3-dimensional axis to one- or a two- dimensional axis. Thus, the presented methods are easy to understand theoretically and make it easy to master the intracorporeal knot.