The axial-spin technique of intracorporeal knot tying: a novel and simplified approach for junior residents.

Since its introduction, laparoscopic surgery has been limited by various factors including 2-dimensional vision and limited spatial mobility of instruments. A major limitation of conventional laparoscopic surgery is the placement of an intracorporeal knot, which requires a significant amount of training and practice. We describe a novel, easier technique of intracorporeal knot tying using a right-angled 10 mm grasper/mixter. After passing the suture through the tissue, the right-angled grasper is used to create a V-shaped configuration of the armed end of the suture while it is being stabilized distally by the needle driver in the opposite hand. The jaws of the right-angled grasper are then twisted axially using the thumb-dial, thereby converting the V-shaped configuration to that of an alpha, with the jaws of the instrument through the loop. After stabilizing the loop, the jaws of the right-angled grasper are then opened and the free end of the suture is grasped and pulled through in the appropriate direction. By rotating the thumb-dial in the opposite direction, the configuration of the knots can be varied to create slip knots or square knots. The technique involves the use of an extra component, namely the thumb-dial of the instrument. Much simpler than techniques currently in use, especially when training new surgeons, it avoids the cumbersome 3-dimensional spatial movements needed to perform conventional intracorporeal knots.