A novel ligation technique facilitating minithoracotomy.

Abstract

We describe a simple knot tying technique that facilitates minithoracotomy, can be rapidly executed, and is easy to learn. The technique is described in detail as a stepwise approach with photographs. A total of 117 consecutive patients underwent elective minithoracotomy in which this novel deep ligation technique was used during the past 16 months. Those patients included 54 with anatomic lung resection, 29 with esophagectomy, and 34 with other operations. Knot security has been adequate with this knot, as evidenced by its clinical performance and our experiences to date. This novel knot-tying method promotes the expeditious formation of secure square knots in deep-seated operating fields through a small incision. It provides an improved visualization, gentle manipulation of tissue, and precise placement of sutures within a confined space. The surgeon who has learned this new tissue approximation skill will return suturing and knot tying to the forefront of minimally invasive surgery in a cost-effective and efficient way.