Laparoscopic knot substitutes. An assessment of techniques of securing sutures through the laparoscope.

: Advanced interventional laparoscopy has required the development of new methods of securing sutures as alternatives to the three-throw reef knot. A tensiometer was designed to measure the forces required for distraction of various knots or securing devices with different sutures. A three-throw reef knot was used as a control. Each device was tested 15 times, and the tension at which the "knot" slipped was recorded. Titanium clips (Ligaclip, Ethicon), locking polydioxanone clips (Absolok and Lapra-ty, Ethicon), malleable collars, Roeder knots and biocompatible glue (Histoacryl, B Braun Melsungen AG) were all assessed. Sutures secured with Ligaclips, Absolok clips and glue were significantly weaker than the three-throw reef knot. Sutures secured with malleable collars and Lapra-ty clips were as strong as the three-throw reef knot and have potential for use as knot substitutes.