Making loops in laparoscopic surgery: state of the art

Premade chromic gut ligating Endoloops used in laparoscopic surgery are not always available. Handmade knots or loops, however, are equally effective, simpler, cheaper, and readily available. Techniques of making more than 10 handmade knots and loops are described and illustrated, and their uses are discussed. The thread can be introduced inside the abdominal cavity to loop around the proposed structure grasped by forceps, brought outside the abdomen, tied externally, and the knot pushed and tightened inside by pusher rod. Or, the knot may be fashioned outside the abdomen and introduced as a ready-made loop and tightened inside by a grasper.