A New Technique for Making the Aberdeen Knot in Laparoscopic Surgery.

Abstract

Laparoscopic knot-tying is an advanced skill. The traditional square knot or surgeon's knot is often used at the end of a continuous suture line in laparoscopic surgery. The Aberdeen knot has been shown to be stronger and more secure than the surgeon's knot for ending a suture line but is rarely used in laparoscopic surgery. We have developed a new technique to make the Aberdeen knot laparoscopically. At the end of a continuous suture line, the needle-attached end of the suture is held with a right-handed instrument and passed through the instrument into the loop of the last suture. The left-handed instrument is passed through the triangle made by the inserted suture, the right-handed instrument, and the loop through which the suture is inserted. The suture held by the right-handed instrument is then pulled, closing that loop and creating a new one on the left-handed instrument. The right-handed instrument is passed into the loop, and the same technique is then repeated two or more times. To finish the knot, the needle-attached end is passed through the loop, and the knot is tied. Laparoscopic suturing and knotting are difficult, particularly in single-port laparoscopic surgery, where the angle between working instruments is narrow. Furthermore, knotting the end of a continuous suture is difficult when the thread becomes short. In all of these situations, this technique is able to facilitate and simplify knot-tying. No special instruments are required to make a "laparoscopic Aberdeen knot."