This precaution is appropriate because Square Knots are notoriously unreliable and because the completed knot is often hard to see вЂ“ it could comprise a stack of slippery Half Hitches instead of the intended stack of Square (Reef) Knots. Repetition: The sequence shown in the animation is usually repeated to provide security. An Instructor sitting opposite a student may find it helpful to use the Inverted or Rotated views. Learning and Teaching: Most right-handed students will prefer the Normal view and left-handed students the Mirror view. Alternative techniques include the Two Hand Technique, the Instrument Tie, and the Surgical Slip Tie. This maintains tension in the first Half Knot while the additional locking half knot is being tied. The distinctive feature of a Surgical Tie Knot is that the technique keeps the ends taut during the tying process. Techniques: In the One-Hand technique the end of the suture is Pulled through to form the knot. The use of the harmonic scalpel for the control of thyroid vessels during thyroid surgery is safe, and it shortens the operative time by almost 30 minutes compared with the conventional technique for both unilateral lobectomy or total thyroidectomy procedures.Uses: The Surgical Tie Knot is a Square (Reef) Knot ( ABOK # 460, p 75.) It is widely used in surgery although less secure than the Ligature Knot, which starts with an initial Double Throw Knot. There was no effect of tumor size on operative time (Pearson correlation factors: 0.14 for total, 0.21 for unilateral thyroidectomy). There was no difference between the 2 techniques regarding the amount of blood loss for different procedures. Mean +/- SD operative time was shorter in the harmonic scalpel group compared with the conventional technique group for both lobectomy (89 +/- 20 minutes vs 115 +/- 25 minutes P<.01) and total thyroidectomy (132 +/- 39 minutes vs 161 +/- 42 minutes P<.01) procedures. Mean +/- SD thyroid size tended to be larger in the harmonic scalpel group for both lobectomy (5.1 +/- 2.6 cm vs 4.2 +/- 2.2 cm P =.06) and total thyroidectomy specimens (6.3 +/- 3.8 cm vs 4.8 +/- 2.9 cm P =.08) compared with the conventional technique. There were no intraoperative complications. The 2 groups were similar regarding age and sex. One hundred seventy-one consecutive patients undergoing lobectomy or total thyroidectomy by one surgeon (A.E.S.).Д®ighty-six patients underwent thyroid surgery with the conventional clamp-and-tie technique (lobectomy, n = 49 total thyroidectomy, n = 36) and 85 with the harmonic scalpel (lobectomy, n = 38 total thyroidectomy, n = 47).Дemographics, pathological characteristics, thyroid size, operative time, blood loss, and complications using a 2-tailed t test, chi(2)test, and Wilcoxon rank sum test. We hypothesized that the use of the harmonic scalpel could lead to a significant reduction in operative time as compared with knot tying in thyroid surgery. The harmonic scalpel, using ultrasonic frictional heating to ligate vessels, is widely used in laparoscopic surgery, but there is little experience in open thyroidectomy. The technique of thyroidectomy has undergone little change in several decades.

Stanford surgery knot tying video