title: The 4-S modification of the Roeder knot: how to tie it.
abstract: BACKGROUND
  The 4-S modification of the Roeder knot may be tied laparoscopically as a single-throw knot.
  
  
  METHODS
  It is tied by adding a fourth wrap around the suture loop and securing the loop in place with a square knot rather than a single half-hitch.
  
  
  RESULTS
  We have used this knot in laparoscopic surgeries for more than 2 years and have not observed knot slippage.
  
  
  CONCLUSIONS
  This modification results in a knot comparable in strength to the strongest laparoscopic multiple-throw square knots.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: H T
authors.initials: HT
authors.lastname: Sharp
authors.forename: J H
authors.initials: JH
authors.lastname: Dorsey
mesh_terms: D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy / Q000379:methods*; D010052:Ovariectomy; D013536:Suture Techniques / Q000592:standards*; D013718:Tensile Strength; D016896:Treatment Outcome