title: Novel method of the double-loop slip-knot: preknotting on the laparoscopic forceps enables easy and secure intracorporeal ligation.
abstract: BACKGROUND
  Laparoscopic ligation is a difficult and advanced technique because of the limited movement of forceps under two-dimensional videoscopic view. Currently, single-port surgery is widely used and a simple method for intracorporeal ligation is required. We describe an intracorporeal slip-knot with a double-loop strand that can be used to provide security and present the experimental results obtained.
  
  
  METHODS
  A modified Eskimo bowline with a 4-0 absorbable monofilament was placed on a needle driver, and the forceps was used to grip both ends of the thread. Another forceps was used to pass the line under vessels in the abdominal cavity. The line was withdrawn from the gripping point through the preknot on the rod after it was gripped at the same point. The slip-knot was tightened, and a pushing forceps and a needle driver were used to push the knot and complete the ligation.
  
  
  RESULTS
  The double-loop slip-knot has a high bursting pressure compatible with that of a conventional square-to-slip knot, which is significantly higher than that of any other slip-knot. In an experimental evaluation on animal laparoscopy, residents performed complete ligations of gastric and colonic arteries and veins within 30 s after a short explanation of the procedure.
  
  
  CONCLUSIONS
  This novel slip-knot with a double-strand loop could provide easy and secure intracorporeal ligation. This type of slip-knot has great potential for wide use in open surgery using laparoscopy. Further evaluation is required to determine its clinical applicability.
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan. asaot@med.gunma-u.ac.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asao
authors.forename: So-ichi
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: Yamaguchi
authors.initials: Y
authors.lastname: Satoru
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujii
authors.forename: Erito
authors.initials: E
authors.lastname: Mochiki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000818:Animals; D004867:Equipment Design; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000379:methods; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine