This is a useful knot to bring two tissues together which may be more difficult with a standard knot. An example would be to bring the small bowel up to the stomach for a gastrojejunostomy or constructing the wrap in a fundoplication. Stage 1 Holding the needle in the right needle holder Insert the needle into the right side of the incision Push the needle through to the other side of the incision at a perpendicular angle Pull the needle through with the left needle holder and then pull the thread leaving enough of the tail to use later, approximately one inch Holding the head with the right needle holder perform one throw over around the left needle holder Push the left needle holder through the throw over to grab the tail Pull through Leave the tail on the right side of the incision Stage 2 Holding the head with the right needle holder Perform one throw over the left needle holder Push the left needle holder through and grab the tail Pull through Stage 3 With the right grasper hold the head vertically Hold the tail with the left needle holder Pull upwards on the right needle holder The knot should slide down towards the skin patch Slide the knot with the left needle holder if necessary The knot should be snug against the skin patch Stage 4 With the head in the left needle holder Perform one throw over around the right needle holder Push the right needle holder through and grab the tail Holding both sides of the thread pull through Place both sides of the thread in one needle holder and using laparoscopic scissors cut the threads This article was published on 2024-02-06
