A Novel Sliding Knot Technique Without a Knot Pusher for Laparoscopic Pelvic Floor Surgery

Challenges in intracorporeal knot tying can be addressed with extracorporeal slip knots, simplifying the process of tying and managing tissue tension using a knot pusher. However, existing extracorporeal knot techniques are difficult owing to their complexity, the finesse required with thin yarns, and extensive training needs. We developed a new laparoscopic extracorporeal slip knot technique that can be used with a conventional needle driver or standard clamps, offering the advantages of being cost-effective and easy to learn.

The technique involves passing the active strand over another loop and securing it with the nondominant hand. A Kelly clamp is then wound around both loops three times in a tornado-like motion, passing the instrument over the active loop and under the passive one, and grasping the active strand. The passive strand is pulled to approximate the knot to the tissue and is tightened by the tension of the passive strand.

This method has proven effective in various laparoscopic procedures such as sacrocolpopexy, colposuspension, pectopexy, myomectomy, and hysterectomy, facilitating surgeries without complications.

The tornado knot technique is a feasible and safely locked sliding extracorporeal knot that can be easily learned, especially by surgeons who are accustomed to open surgery.