Laparoscopic Intracorporeal Cinch Knots: Changing the Square Knot Paradigm

Abstract

Reliable knot tying is a cornerstone of surgical technique, and the square knot and surgeon’s knot constitute the greatest part of most surgeons’ knot-tying skills. Traditionally, laparoscopic intracorporeal knot tying of a square knot or surgeon’s knot is a direct translation from an open instrument tying technique. Given the technical and mechanical challenges imposed by standard laparoscopic instrumentation, performance of such a basic task is sometimes difficult and elusive, even for accomplished surgeons. Consequently, myriad technologies and techniques are used as work-arounds for this basic surgical task. However, the sometimes necessary tying of a snug and reliable intracorporeal knot is unavoidable. That laparoscopic intracorporeal knot tying must be translated from a 2-handed open surgical technique using flat knots deserves reassessment. Cinch knots, with unusual sliding and tightening properties, are currently used in surgery. With apparent complexity and exacting construction requirements, however, primary intracorporeal knot tying has not been described. Described herein is a technique for doing so. Also included is a review of cinch knot mechanics, an understanding of a fundamental scheme for their construction, and basic instrument maneuvers that enable easier intracorporeal tying of a most reliable knot, useful for multiport and, in particular, single-port laparoscopic knot tying.