YS knot: A new technique for a tension-controlled slip knot using a trocar

Abstract

The Yoon Soon (YS) knot is a laparoscopic extracorporeal slip knot that is easy to learn and apply. Our new technique, which uses the trocar as a knot pusher, is simpler, faster, and has more tension than conventional knot methods. The YS knot will help surgeons save operative time and perform tension-controlled knot-tying during laparoscopic surgery.

Keywords: Knot; Knot pusher; Laparoscopy; Surgical instruments; Tension.

Fig. 1. The YS (Yoon Soon) knot has mainly been used for vaginal cuff closure after simple or radical hysterectomy (A) and uterine repair after myomectomy (B).

Fig. 2. Steps of the YS (Yoon Soon) knot. (A) The brown strand is the axon strand. The overhand throw of the wrapping strand is made over the axon strand with the dominant hand twice (two hitches). (B) The overhand throw of the wrapping strand is made over both strands with a mosquito or Kelly forceps once (one wind). (C) A locking hitch is made by passing the end of the wrapping strand through the last loop with a mosquito or Kelly forceps once (one locking hitch). (D) The trocar tip advances the knot over the axon strand and locates the knot in close proximity to the stitched tissue. (E) The knot is tightly fixed by retraction of the axon strand while holding the trocar tip up at the knot.