Laparoscopic Weston Knot



This video demonstrates laparoscopic Weston Knot. Weston knot is an extracorporeal knot. Laparoscopic Weston knot has one advantage that it can be applied without a knot pusher. The Weston knot performed well in both braided and monofilament suture.

Laparoscopic suturing is one of the most critical technical skills in minimal access surgery. Among various extracorporeal knotting techniques, the Laparoscopic Extracorporeal Weston Knot has gained importance for its simplicity, sliding efficiency, and secure tissue approximation. At World Laparoscopy Hospital (WLH), this knot is taught as part of advanced laparoscopic skill development programs, helping surgeons and gynecologists master safe and reproducible suturing techniques.

Introduction to Weston Knot

The Weston knot was originally described by Dr. Peter Weston in 1991. Initially used outside laparoscopy, it was later adapted by endoscopic surgeons as an elegant sliding knot suitable for minimally invasive procedures.

The extracorporeal version involves forming the knot outside the patient’s body and then sliding it inside through a trocar using a suture passer. This approach simplifies knot formation and reduces intracorporeal technical difficulty.

Concept of Extracorporeal Weston Knot

Extracorporeal knotting means:

• Knot is tied outside the body

• Knot is slid into position inside the abdomen

• Tissue or vessel is securely ligated using tension control

This technique is widely used in minimally invasive procedures such as treatment of endometriosis, ovarian cysts, fibroids, and other laparoscopic tissue ligations.

Technical Characteristics

The Weston knot is:

• A self-locking sliding knot

• Configured typically in 1-1-1 pattern (hitch, reverse hitch, final wrap)

• Designed for smooth sliding followed by secure locking

It allows multiple knots to be applied using a single suture length and often does not require a knot pusher, making it efficient during laparoscopic suturing.

Surgical Applications

The extracorporeal Weston knot is commonly used for:

• Vaginal vault closure

• Crural repair in fundoplication

• Gastric band suturing support

• Tubal ligation and stump ligation

• General tissue approximation

It is also useful when sutures must slide smoothly through tissue and anchoring devices.