Knot tying and suturing technique
Intracorporeal suturing and knot-tying in laparoscopic surgery require great manual dexterity; these techniques must absolutely be mastered by every surgeon who is interested in pursuing the minimally invasive approach. Although minimally invasive surgery reproduces the same technical phases of traditional surgery, there are still some specific differences due to the limits inherent to its method. One of the most difficult acts in laparoscopic surgery is the knot-tying and suturing technique. The knots performed laparoscopically must be as safe as the traditionally performed ones. Fundamental elements are the easiness and rapidity of execution, the tightness of the knot and its possibility of reproduction. It is important to remember that the safety of the knot depends not only on the knot itself, but also on the type of material used. For instance, any material that swells at the contact with water after having being introduced into the body theoretically increases its capacity of tying and tightening.
Therefore, knots made from catgut, dacron, polyglactin and lactomer can be considered safe, whereas ones made from PDS, silk or polyamide are less reliable.
The tightness of an extracorporeal knot made from a 2/0 thread is the double of a 3/0 thread.