Comparing Extracorporeal Knots in Laparoscopy using Knot and Loop Securities

Background: Laparoscopic knot tying is a basic surgical skill that has been practiced for centuries having their roots in fi shing and sailing.1-4 The advent of endoscopic surgery placed more challenges on the surgeons and this ever growing skills need to be acquired. Since endoscopic and arthroscopic knots must be delivered over a distance to a tissue with minimal access maintaining tension is more important than the knot confi guration chosen.5,6 The aim of this article review is to determine which hand tied knot confi guration and possibly, suture size, and suture type that would be safe in laparoscopic surgery. Materials and methods: A literature review was performed using PubMed, Springerlink, Highwire press and search engines like Google and Yahoo. The following search terms were used: extracorporeal knot, arthroscopic knots, Roeder’s knot, Meltzer’s knot, Mishra’s knot, Duncan knot, Nicky’s knot, SMC knot, Weston knot and Tennessee extracorporeal knot. A total of 48,100 citations were found. Selected papers were screened for further references. Publications that featured illustrations of sliding knots with statistical methods of analysis were selected. More than 20 different sliding knots were used for this review. Result: Eighty-one articles were reviewed. Most studies have evaluated knot security only and few studies have evaluated simultaneous both loop and knot security and also only a few compared knot and loop securities to the type of suture materials and their sizes. The addition of three RHAPs improves knot security of all sliding knots tested and improves the loop security of most of the sliding knots tested. Conclusion: The safety of extracorporeal knot depends on knot confi guration, especially when further RHAPs are included.