Different Blocking Sequences Performed by Laparoscopy.

STUDY OBJECTIVE

To demonstrate the application of different knot blocking sequences in laparoscopic surgery.

DESIGN

A step-by-step demonstration of different blocking sequences performed by laparoscopic surgery (Canadian Task Force classification III).

SETTING

Private hospital in Curitiba, Paraná, Brazil.

INTERVENTION

The correct placement of one knot over the other is rarely taught in the surgical literature. Laparoscopic knot-tying techniques may be performed using one hand (monomanual technique) or alternating both hands (bimanual technique). Rotation of the needle holders around the thread (clockwise or counterclockwise rotation) is very important to have a symmetric or an asymmetric configuration of the knot, which affects the stability of the entire knot sequence. The monomanual knot-tying technique needs to alternate the rotation of the needle holder, and the bimanual technique does not when performing half knots (square or flat knots). The half hitch is an asymmetric knot that is obtained when the surgeon makes asymmetric traction on one thread (passive thread) and place the knot using the other thread (active thread). To block 2 half hitches, the surgeon needs to change the active and the passive threads. Beginners in laparoscopy commonly make mistakes tying knots, leading to an insecure knot sequence that may slip and/or open under minimal forces. In this video, we demonstrate different types of blocking sequences performed by laparoscopy applied in different surgical procedures. Ethics Committee approval was obtained for this video.

CONCLUSION

Knot-tying is a basic surgical skill that must be mastered by all laparoscopists.