Slip Knot

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

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