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World J Surg. 2008 Apr;32(4):648-55. doi: 10.1007/s00268-007-9359-x.

Heraklas on knots: sixteen surgical nooses and knots from the first century A.D.

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Section of Surgical Oncological Disciplines, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066, CX, Amsterdam, The Netherlands.


In the first century of our common era, the Greek physician Heraklas wrote a brief essay on how to tie 16 knots and nooses for surgical and orthopedic purposes. His work is reintroduced and discussed here because its place in the origin and evolution of surgery needs to be properly acknowledged and recorded in the current medical literature. To do so, Raeder's definitive Greek edition of the oldest extant manuscripts of Heraklas' essay was studied along with the various illustrated interpretations of his text published over the last six centuries. Moreover, the contemporary literature was searched for current applications of Heraklas' knots by use of a database of surgical knots. It was found that seven of Heraklas' 16 knots and nooses were still applied surgically of late, and that four of these have even been recently rediscovered for such applications. Therefore, it is concluded that Hellenistic, Roman, and Byzantine medicine had a rich knowledge and high standards. Contemporary surgical techniques may be found to be truly ancient if we search deep enough, far enough, and long enough.

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