'Homemade' knot pusher for extracorporeal ties.

We describe a 'homemade' knot pusher modified from a conventional right angle dissector for extracorporeal ties. The knot pusher has the advantage of allowing the operator to control the tension applied to the structure to be ligated. The instrument can be made with simple tools and its use can be easily learnt. We have used this device in 10 video assisted thoracoscopic lobectomies (over 100 applications on pulmonary vascular structures) without complications. This device can also be used in 'open' surgery when knot tying is needed through a deep wound.