The challenge of intracorporeal knot tying in laparoscopic surgery can be significantly mitigated with the use of extracorporeal slip knots. These allow for easy knot tying and tension management between approximated tissues with the help of a knot pusher. Nonetheless, established extracorporeal knot techniques often present a steep learning curve due to the precision, dexterity with thin sutures, and extensive training they require. To address these hurdles, we have developed a novel laparoscopic extracorporeal slip knot technique. This method is compatible with conventional needle drivers or clamps, similar to those used in open surgeries, offering the benefits of being both cost-effective and straightforward to master and implement.

Initiate by crossing the active suture strand over the loop and securing the intersection between the thumb and index finger of the non-dominant hand. Utilize a Kelly clamp to wrap around both suture loops three times, emulating a "tornado" motion. Then, navigate the tip of the clamp over the active loop and beneath the passive loop, seizing the active strand's limb with the clamp. By pulling on the passive strand, the knot is drawn close to the targeted tissue. Finalize by tightening and securing the knot through the tension on the passive strand.

This innovative knotting technique has been successfully applied in a variety of laparoscopic procedures, including sacrocolpopexy, colposuspension, pectopexy, myomectomy, and hysterectomy, enhancing operational efficiency without any complications or difficulties.

The newly introduced technique, which leverages conventional hand instruments and can be executed with a needle holder acting as a knot pusher—or even without a knot pusher—is practical, swift, robust, and capable of exerting greater tension compared to traditional knotting methods.

Karaoglan T, Aydin S, Bilginer U. Development of a Low-Fidelity Laparoscopic Sacrocolpopexy Simulation Model and Evaluation of Curriculum. Female Pelvic Med Reconstr Surg. 2021;27(8):474-80.
Ivy JJ, Unger JB, Hurt J, Mukherjee D. The effect of number of throws on knot security with nonidentical sliding knots. Am J Obstet Gynecol. 2004;191(5):1618-20.
Lee YH, Kim MJ, Chong GO, Hong DG, Lee J, Lee YS. YS knot: A new technique for a tension-controlled slip knot using a trocar. Obstet Gynecol Sci. 2015;58(2):171-4

Continence 12S (2024) 101531
DOI: 10.1016/j.cont.2024.101531