Laparoscopic Weston Knot Demonstration

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The Weston knot was described by Dr. Peter Weston, a gynaecologist working in San Antonio in Texas, USA in 1991. The knot was not originally designed to be used at laparoscopy, but has been adopted by endoscopic surgeons as a very elegant slip knot.

This video shows a Weston knot being tied. Note the double half-hitches at the beginning but we only use a single half-hitch at the end for locking. As with the Roeder knot, we usually use vicryl sutures (2/0 to 1) depending on the tissue being sutured. However, as the Weston needs a longer lengths of suture outside the abdomen, we tend to use it less than the Roeder knot.

A static surgeon’s knot provides the best balance of loop security and knot security within the knot configurations. A sliding knot without RHAPs has both poor loop security and knot security and should not be tied. The addition of 3 RHAPs improves knot security of all sliding knots tested and improves the loop security of most of the sliding knots tested. Loop security is a primary determining factor. The knot chosen should be the one which the surgeon can easily and reproducibly tie with good knot and loop security.


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