The tensioKNOT instrument set for endoscopic ligation and suture-knot formation and application

SummaryIn minimally invasive surgery (MIS), intracorporal knot-tying becomes complicated due to the limited field of vision and depth perception. At the tip of the tensioKNOT instrument, there is a needle driver of 3 mm with a slipfit hollow knot pusher. The knot is extracorporally attached by the quick formation of three loops by hand. After intra-abdominal insertion, the stitch or ligation is performed under endoscopic vision. The knot is pushed onto the standing end of the thread, doubled in an additional loop, and tightened with the integrated knot pusher. This loop allows an increase in the reverse slipping force without troublesome instrument change. The feasibility of the instrument set and the strength of the knot were proved in pigs and in 48 cholecystectomies and hernia repairs in humans. The independent extracorporal formation of a knot on a second tensioKNOT instrument allows quick application of a secured slip knot, equivalent to the use of clips and staples. As a result, cost saving is high.