What is the Best Surgeon's Knot? Evaluation of the Security of the Different Laparoscopic Knot Combinations

To investigate the security of various knot combinations in laparoscopic surgery. Prospective nonrandomized trial (Canadian Task Force classification II). Storz Training Centre, Sao Paulo, Brazil. Different knot combinations (n = 2000) were performed in a laparoscopic trainer. Dry or wet 2.0 polyglycolic acid or dry 2-0 poliglecaprone 25 was used. The tails were cut at 10 mm, and the loops were tested in a dynamometer. The primary endpoints were the forces at which the knot combination opened or at which the suture broke. Resulting tail lengths were measured. Surprisingly, the combination of a 2-throw half knot (H2) and a symmetric 1-throw half knot (H1s) (a surgical flat knot) opened at