Extracorporeal knots in laparoscopic surgery can be used in certain situations or as a bridge to mastering more technically demanding intracorporeal suturing.
Minimal invasive surgery (MIS) has become the preferred technique for many surgeries, because it is less painful, permits earlier return to work, provides better cosmesis, and is more acceptable to the patient than traditional surgeries.
Advanced Minimal invasive surgery (MIS) requires that the surgeon be adept at intracorporeal suturing and knot tying. However, mastering this skill is a difficult process with a long and steep learning curve. Extracorporeal knots permit the knot to be tied outside and then, by using a knot pusher, applied snugly inside the body.
There are many variants of the extracorporeal slip knot: Roeder knot, Duncan loop, Nicky’s knot, Tennessee slider, SMC knot, Weston knot, Meltzer, Tayside knot, and others. These extracorporeal knot tying techniques are variations in turn around the axis or the number of reversed half hitches on alternating post.
Each technique has its proponents and some have been modified for improvement, but there are constraints with these techniques in terms of size of suture material, the numbers of knots that can be applied at once, and the ease of sliding in the extracorporeal knot.
One of many methods to close the colpotomy after total laparoscopic hysterectomy, Dr. Robert Oehler present a knot that is simple, easy, and fulfills all the qualities of an extracorporeal knot.
A stepwise, educational approach is chosen to explain the various steps such as needle introduction, loading the needle, suturing and extracorporeal knot tying. Practicing these steps in a pelvi trainer will likely increase skills levels and transfer into better quality and less time taken in actual surgery.
The average time taken to create the final configuration of the knot was 20 seconds, while it was 30 seconds for the Roeder’s knot. This knot is drawn from the art of tatting; which has been used throughout the ages. This shows that the technique is easy to learn, easy to teach, and does not have a long steep learning curve.