A new method of laparoscopic instrument knot tying

The following is an introduction to a new intracorporeal knot-tying technique which brings the open, manual knotting method into the realm of laparoscopic surgery. This technique broadens the range of tissue approximation by suturing methods to include those that are performed at open surgery. Unique among all known knotting methods, it is performed with a multifunctional needle-holding instrument with a loop-forming spur member. The instrument includes important ergonomic features in its design and can be easily dismantled for inspection, cleaning, and sterilization by autoclave. In essence, the technique is a one-handed hand-tie action completed with two instruments where simple forward and rotation movement of the instrument mimics the role of the hooked index finger.