A new reusable instrument designed for simple and secure knot tying in laparoscopic surgery

This new instrument is a metal cannula designed for use in creating controlled intracorporeal knots similar to instrument ties used in open surgery. It can therefore be used in a number of situations in laparoscopic surgery for ligation in continuity-for example, of the undivided cystic duct or of a vascular pedicle or for ligation of the cut end of a pedicle held in artery forceps. The cannula is designed to be loaded with 0 suture material and has a tip that readily penetrates the abdominal wall through a 3-mm skin incision, so it can be introduced either directly or through an introducer sleeve in a laparoscopic port. A curved dissecting forceps is used for knot formation. The knot is tightened by pushing the cannula with the other hand, and further throws are applied. The tip is profiled so that the knot, which is formed is pushed down into position without slippage or damage to the suture material.