How to reuse endoloop ligature in laparoscopic appendectomy: An inexpensive environment-friendly approach

Uluslararası Sağlık Bilimleri ve Yaşam Kongresi’nin altıncısını 2-5 Mart 2023 tarihleri arasında Burdur Mehmet Akif Ersoy Üniversitesi’nde gerçekleştirileceğini duyurmaktan ve sizleri bu bilimsel toplantıya davet etmekten onur duymaktayız.

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.

 a. The suture is inserted through the tip of the plastic tube. b.The suture is pushed out gently until it is seen at the other end of the plastic tube. c. Nicky’s knot is prepared extracorporeally. d. The metal part is pulled out after the Nicky’s knot is placed properly at the base of the appendix. e. The plastic tube is gently pulled out. The plastic tube is normally discarded after use. However, we suggest keeping the plastic tube and repreparing the Nicky’s knot extracorporeally in order to use it in another laparoscopic appendectomy operation.

Financial Disclosure: The authors declared that this study received no financial support.