Interrupted laparoscopic suture secured with the needle-through-the-sliding-loop knot.

A special needle holder with a step and knot-forming stand was designed to permit wrapping sutures into distinctive sliding loops around the needle holder, outside the abdomen. The loaded instrument was introduced into the abdomen and the appropriate stitch was made. The suture next to the needle was grasped with the needle holder and pulled through the sliding loops(s) to establish a knot. When the needle was passed through a simple noose the needle-through-the-noose knot was created. This knot maintained tension on captured tissues, but it required additional half-hitches to secure. When the needle was passed through rolling hitch loops it established a knot that was secure in simple applications, but required one additional half-hitch to secure in vulnerable applications involving slippery sutures or tissue purchases subjected to disruptive tension. The procedures were first practiced on inanimate models using a laparoscopy training simulator and then performed successfully over 20 times in 11 patients who had laparoscopic myomectomy or hysterectomy.