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https://ihslc.mehmetakif.edu.tr/
HOW
TO REUSE ENDOLOOP LIGATURE IN LAPAROSCOPIC APPENDECTOMY: AN INEXPENSIVE
ENVIRONMENT-FRIENDLY APPROACH
Mehmet Eren Yuksel1,
Mustafa Sami Bostan2, Namık Ozkan2
1- Ankara Yıldırım
Beyazıt University School of Medicine, Intensive Care Unit
e-mail: doctormehmeteren@yahoo.com
2- Tokat Gaziosmanpasa
University School of Medicine, Department of General Surgery
e-mail:
mustafasamibostan@gmail.com, e-mail: namikozkan@yahoo.com
Abstract:
Endoloop
Ligature is a 45-cm-long ligature inserted in a plastic tube with a previously
prepared suture loop at its tip (www.jnjmedtech.com/en-US/product/endoloop-ligature). Endoloop
Ligature is used to faciliate both placing and tying a knot at the root of the
appendix during laparoscopic appendectomy. However, Endoloop Loop costs
approximately 170 US Dollars, depending on the retailer’s price list. Moreover,
its plastic tube is discarded after use. Therefore, we suggest reusing Endoloop
Ligature by re-inserting either polyglactin (Vicryl) or polydioxanone (PDS)
suture through the narrow end of the plastic tube and reforming the ligature
loop by hand. Afterwards, the knot is placed at the base of the appendix as
before. This method is both inexpensive as only polyglactin (Vicryl) suture is
used and it is environment-friendly as the plastic part is reused, not
discarded.
During laparoscopic
appendectomy, after tying the knot at the root of the appendix, both the metal and
plastic parts of Endoloop are discarded. However, Vicryl® (polyglactin 910) or
monofilament PDS® II (polydioxanone) sutures can be used to to reestablish
Endoloop for further usage. First of all, the new suture is inserted gently
through the tip of the plastic part of Endoloop. As the thread reaches to the
end of the blunt part of the plastic tube, the suture is pulled out thorough
the opening (Figure a-b). Afterwards, a
suture loop is prepared at the narrow end of the plastic tube. Some of the
well-known and widely used sliding knots are Nicky’s knot, Duncan loop,
Tennessee slider, Roeder knot and Weston knot. Hereby, we used Nicky’s knot (Figure
c-d). The newly prepared Endoloop is now ready to use. The plastic tube within
the metal cover is inserted gently through the trocar, the ligature loop is
placed at the root of the appendix and the the ligature coming out from the
blunt side of the plastic tube is pulled out to tighten the ligature loop (Figure
d-e). Afterwards, appendectomy is
performed above the suture line. The braided vicryl (polyglactin 910) suture is
expected to be absorbed in 56-70 days, or monofilament PDS II (polydioxanone)
suture is awaited to be absorbed in 180-210 days. This method is both
inexpensive as only polyglactin (Vicryl) suture is used, and it is
environment-friendly as the plastic part is reused, not discarded.
Financial Disclosure: The authors declared that this study received no financial support.
