![]() ![]() Because all loops would be disassembled after the post limb is removed from the knot, a salvage procedure is proposed to save the suture from unintentional premature locking. Therefore, the loop limb should not be over-tensioned while sliding down the knot the knot should always be “pulled” down, rather than “pushed” down, onto the target tissues. Figure 2.10: Knot tying technique with Endo Stitch. Pulling the loop limb simultaneously on both sides of the knot could trigger premature knot flipping. Three simple knot-tying methods are presented the choice of which to use is based on the surgeon's preference. Reversed half-hitches on alternating posts for secondary knot security can be added, but to save surgical time, these are not obligatory. The Surgical Knot Tying Board develops eye-hand coordination and ambidexterity in surgical knot tying. 5,6 According to Rosser et al., 7 intracorporeal suturing is perhaps the most difficult of the advanced laparoscopic skills. We describe a sliding knot that is ideally lockable by transforming the original simple figure-of-8 configuration into a true interlocking, low-profile knot with an α-α configuration that creates strong primary knot security when tying is finished. Suturing and knot tying have an important place in laparoscopic surgery. ![]()
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