These methods utilising the Mertie Needle Holder are unique and demystify the techniques of endoscopic knot tying.

The following diagrams display three applications of the method:

  1. Instrument Method
  2. Innovative instrument method (hand tie technique) 
  3. Combination method



1. Instrument Method

Diagram 5 Open surgical method

  1. Configuration of a C formation on the bight with the R instrument.
  2. L clockwise rotation and advance to form the reverse directed loop on the suture.
  3. L grasps the tail, rotated anticlockwise and withdrawn.
  4. The first halfhitch.
  5. L transferred and holds the suture in a C loop configuration.
    R released from bight and the jaw is closed.
    Next anticlockwise rotation of R around the suture forms the second reverse loop on the bight.
  6. R grasps the tail.
  7. R rotates clockwise and withdraws the tail.
  8. Completed square knot. Instrument separation tightens the knot.



2. Innovative instrument method

Diagram 6 Hand tie method, performed with instruments

  1. R holds tail, L holds the bight.
  2. R anti-clockwise rotation over the bight, the spur captures the suture to form a
    loop under the bight. Clockwise rotation of L can assist this loop formation.
  3. Further R anti-clockwise rotation under bight and through the loop. A double loop,
    sugical half hitch can easily be formed by further rotation of R around the bight.
    L transfers to grasp the tail.
  4. Release suture tail from R, close R jaw then clockwise rotation and withdrawal.
  5. R grasps bight, separation of R and L tightens the half hitch.
  6. anticlockwise rotation of R forms a loop on the bight, clockwise rotation of L over
    bight and advance through the loop. The spur appendage can assist with this loop formation.

Next (not shown) R transfers to grasp tail. Repeat fig. (d) and (e) with the opposite instruments
to complete and tighten the square knot. Further half hitch loops can be performed as needed.



3. Combination Method

Diagram 7 Combination of Instrument and Hand tie methods
Only one instrument interchange needed.

  1. L holds bight in C formation.
  2. R orbital clockwise rotation under the bight forms a reverse loop. or
  3. Two or more loops.
  4. R grasps tail, then followed by clockwise rotation and withdrawal of R.
  5. First half hitch formed, instrument separation tightens the hitch.
    Specific instrument movements, as in open surgery, can create suture
    locking techniques if needed.
  6. R anti-clockwise rotation over, then forward and under the bight creates a
    forward loop. The spur can assist with this loop formation, as does
    clockwise rotation of L.
  7. L transfered to tail, release R, close jaw and clockwise rotational withdrawal of R.
  8. R grasps bight, instrument separation tightens the square knot.