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A Modified Intracorporeal Knot-tying Technique Using an Endoknot Cannula During Laparoscopy: Coiling and Snaring Method

Introduction In minimally invasive surgery, especially single-port access or 2-port surgical technique, the surgical instruments have a limited motion range, which makes knot tying more difficult than in conventional laparoscopy. Materials and Methods Two or 3 loops are formed with the endoknot cannula, and the unlocking of the loops is prevented by compressing it with the graspers (coiling). The formed loops are snared on the grasper, and the free end of the suture is held by the graspers and brought inside the formed loops (snaring). The suture is tied over the tissue using the graspers, and the cannula acts as an integral knot pusher. Results Our modified intracorporeal knot tying is simple, safe and fast to create. Conclusions It will be helpful in any laparoscopic procedure that requires intracorporeal knot tying, especially in single-port or 2-port laparoscopy.