Lariat knot: simple tying technique for robotic and endoscopic sutures

Minimally invasive cardiac surgeries, including robot-assisted and other minimally invasive cardiac surgeries (MICS), have advanced, allowing procedures like mitral valve repair under robotic or video-assisted guidance. Ensuring complete closure of atrial orifices to prevent postoperative bleeding is crucial. This paper introduces the "Lariat knot," a simple and effective technique for secure initial ligation. The Lariat Knot is created by double wrapping the suture to form a loose knot, and then passing the free end through this knot to create an additional loop. The initial loose knot is tightened by pulling the working end, securing the loop. This technique is applied using endoscope or robotic forceps, particularly in closing the left atrium and securing the left-ventricular vent tube. The Lariat Knot technique ensures secure and stable ligation, preventing postoperative bleeding. It is straightforward and applicable in both robotic and conventional endoscopic surgery, eliminating the need for extracorporeal ligation techniques. This method can be combined with other techniques, such as the "Fig. 4 technique," for more stable secondary knots, making it a valuable addition to existing surgical maneuvers.