In laparoscopic surgery, a stronger braided suture is often preferred if the knot pusher is used because suture fraying is a side effect of this technique. Each knot formed has to be guided through a laparoscopic cannula and made tight with a knot-pusher to create the knot. Tying the knot outside the body is simpler for most surgeons because the suture is looped with fingers as in traditional tying. Of these two options knot tying inside the body takes some time to learn because the surgeon is required to use laparoscopic instrumentation rather than his fingers to loop the suture. Tying the knot may be done inside the body or outside the body. While the suture is being put in place a knot is used to secure the suture. The Surgeon's knot has been a standard ligature but in one study it demonstrated slippage. Other commonly employed knots are surgeon's knot, modified surgeon's knot, single-double other side knot, strangle knot and modified miller's knot. The constrictor knot closely resembles the clove hitch except the two ends form an overhand knot under the overriding turn. The constrictor knot is the knot most used for binding. Nevertheless, slipping sometimes happens before the addition of the final knot, particularly during an instrument tie. Ligatures are locked and finished multiple overhand knots. The primary goal of surgical knot tying is to allow the capacity of a knot (or ligature) to be tightened and remain tight. The effective tying of surgical knots is a critical skill for surgeons since if the knot does not stay intact, the consequences may be serious such as after pulmonary resection, laparoscopic cholecystectomy, and hysterectomy. In the past, the training of astronauts has included the tying of surgical knots. Surgical knots have been used since the first century when they were described by Greek physician Heraklas in a monograph on surgical knots and slings. Heraklas' sling XIII, the plinthios brokhos is produced in the same manner as a string figure.

Surgery knot tying