Madany Modification of Tumble Square Knot

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specialty:
General Surgery

Case description

Madany modification of the tumble square knot is done as follow:

1. An intracorporeal surgical knot tying technique was carried out while the left-hand needle holdergrasped the long limb of the thread on the leftside of the cystic duct to perform a double halfknot with the right-hand needle holder in one direction, and the knot tied loosely.

2. Then, a half knot was carried out in the samemanner in the opposite direction.

3. The second half knot was tied with somelooseness.

4. This will allow the positioning of the knot at theproper site.

5. This is the modified tumble square knot, whichcan be changed to a slipping configuration bytightening the thread’s same side, that is,the long limb of the thread and the thread to theleft side of the cystic duct. The same side of thethread should be straightened with the help oftwo needle holders.

6. It was ready to slide after straighteningthe same side of the thread.

7. The partially closed jaws of the needle holder(acting as a knot pusher) will slide theknot to be secured enough to prevent a bile leak.

8. After securing the cystic duct by tightening theknot, the knot is locked again by pulling bothlimbs of the thread.

9. One more knot is tied to prevent theslipping of the modified tumble square knot.

The Madany modification of the Tumble Square Knot enhances knot security during laparoscopic procedures, particularly for cystic duct control.

See our study in the following link: https://journals.lww. com/ejos/fulltext/2024/43020/safety_and_feasibility_of_cystic_duct_control_with.32.aspx.





 

tags: cystic duct surgical technique surgical video case tumble square knot

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