@Article{, title={Extracorporial Knots in Laparoscopic Surgery: Which, When, and How}, author={Omar Salem Khattab, M.B.Ch.B , H.D.S , H.D.L.M , D.MAS, F.I.C.M.S, C.A.B.S}, journal={Journal of the Faculty of Medicine Baghdad مجلة كلية الطب}, volume={50}, number={3}, pages={346-357}, year={2008}, abstract={Despite recent advances in both suture weldingand knotless anchor technology, knot tyingwill remain a necessary skill which thesurgeon must master when performing sutureanchor in laparoscopic surgery. There are anendless number of combinations of knots(sliding versus static, simple versus complex,etc.) and suture types (monofilament versusbraided) to accomplish this task. Surgeons arefamiliar with knotting but seem not to be awareof the possibilities and impact of thetechniques of capsizing, flipping, and flypingknots. (1) Capsizing refers to changing orperverting a flat knot’s geometry underasymmetric stress. The simplest examples ofthis is the change of the overhand knot into ahalf-hitch by putting more tension on its oneend than on the other (Fig. 1A). (2,3,4) Flippingthe knot means to interchange the standing partand working end of the suture, therebyrelocating the knot from one end of the sutureto the other.(5) The half-hitch can be flippedeasily between both ends of a suture (Fig. 1B).Flyping (that rhymes with “typing”) is anarchaic Scottish word that was used to describethe peeling off of a very wet glove of the hand,thereby changes its configuration from a righthandglove to a left-hand one. (6,7,8) .The Scottish physicist Peter GuthrieTait (1831-1901) introduced flyping as a knotting term, inthe late-19th century, to define this “turningoutside in” deformation process of thegeometry of knots. (9) An illustrative exampleof flyping is the change of a series of turns ofthe working end around the standing part, intothe proper blood knot geometry by drawing theproximal turns over the distal ones (Fig. 1C).* Lecturer of Surgery, Dep. Of Surgery, College ofmedicine, Baghdad University, Iraq(7) Ignorance about the techniques ofcapsizing, flipping, and flyping resulted in theintroduction of many allegedly new slidingendoscopic or arthroscopic knots that merelyrepresented configurations of long-knownfishing, sailing, or rigger knots. A knot shouldsecure tissue approximation, simple, easy,quick, and reliable. The aim of this articlereview is to determine which hand tied knotconfiguration, suture size, and suture type thatwould be safe in laparoscopic surgery.Figure

} }