A simple modification to add strength to the Roeder knot.

The Roeder knot is commonly used during laparoscopic suturing because it may be tied extracorporeally and slid down to the target tissue with a single pass of a knot pusher. However, it is significantly weaker than extracorporeally tied knots with several throws. We compared the usual Roeder knot to one that was modified by adding a fourth loop around the standing end of the suture and a second half-hitch to the completed knot. The modified knot (26.6 newtons +/- 15.3) was significantly stronger (p <0.05) than the standard Roeder knot (18.0 newtons +/- 12.1). If a single-pass extracorporeal knot is to be used, we recommend a modified Roeder knot when ligating pedicles at laparoscopy.