THE KNIT STITCH - AN IMPROVED METHOD OF LAPAROSCOPIC KNOT TYING

Intracorporeal suturing is essential to advanced laparoscopy and is a rate-limiting step in many procedures. We have outlined an improved me thod of intracorporeal knot tying which is easier to learn, faster, an d more consistently performed than current methods. Conventional intra corporeal knot-tying technique was compared to the knit-stitch method by ten volunteer surgeons. Each participant tied ten conventional-styl e knots in a video trainer. Surgeons were then taught the knit-stitch method and tied an additional ten knots. Knot-tying times were recorde d and compared. Participants were asked to choose the method they pref erred. The knit-stitch method was demonstrated to be faster than the c onventional method for all participants, regardless of level of traini ng or laparoscopic expertise (mean 63 +/- 19 vs 97 +/- 48 s; P < 0.001 ). The difference was most marked in participants with the least lapar oscopic suturing experience. The knit-stitch was preferred by 90% of t he surgeons. Reasons cited for this preference were ease of learning, conservation of instrument motion, better utilization of the nondomina nt hand, and ability to work with shorter suture. Knit stitching is a faster, more consistent method of intracorporeal suturing. It is prefe rred because of its simplicity, efficiency, and potential to further r educe tissue trauma during the course of laparoscopic suturing.