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Despite the fact that minimally invasive surgery reproduces the techniques of traditional surgery, some differences are specific to this method. Knot-tying and suturing have been recognized as being among the most difficult actions in laparoscopic surgery. The knots must be as safe as those made using traditional techniques. To perform a laparoscopic suture, the surgeon must possess great manual dexterity that is only reached by practising for a long time on the simulator before performing any operation.
The necessary material consists of a pelvitrainer, a laparoscopic needle holder, a grasper, and a needle. For right-handed surgeons, the needle holder should be handled with the right hand and the grasper with the left. Left-handed surgeons should change instruments. The needle should be held perpendicularly to the needle holder axis. After pricking the tissue, the needle holder drops the needle, takes the suture, and pulls it, leaving a tail of less than 2 cm. The suture should be rotated around the grasper twice to make the first knot and, after grasping it with the grasper, both instruments should pull in order to tighten the knot. To avoid causing any damage to intraabdominal organs, both instruments should remain under the laparoscope optic while the surgeon ties the knot. The next throw should be made with just one loop . The next throw should be performed with another single loop in the opposite direction.