Laparoscopic Roeder's Knot - Dr. R.K. Mishra

Laparoscopic Roeder's Knot

Roedner's Knot

            Roeder's Knot

Step 1: The index finger of the assistant may be used to make the extracorporeal knots. The left hand should be used to hold the short limb and the right-hand long limb of thread.

Step 2: The short limb of the thread is crossed over the long limb.

Step 3: The intersection point of thread should be pinched by my left-hand index finger and thumb. At the time of making an intersection, the surgeon should keep sufficient length of short limb, to make it comfortable. It is important to remember that the left hand is used only to hold the intersection point while the right hand will make the necessary hitches and loops.

Step 4:    The short limb is passed between the thread upward.

Step 5:    The short limb should be pulled from up by the right hand to make the first hitch.

Step 6:    The short limb should encircle the thread from below upward.

Step 7:    With the index finger and thumb the tail end is held.

Step 8:    The tail end of the thread is pulled to make the first wind. Step 5 to 7 should be repeated two more times to make three winds.

Step 9:    After making three winds, the tail end is again passed from below up between the threads.

Step 10: Once the tip of tail end projects up, it is pushed down by thumb inside the loop to make a half knot.

Step 11: The tail end is pulled from below to tighten the half knot.

Step 12: Once the knot is configured properly, it should be checked by sliding over the long thread.

Step 13: The tail end of the knot should be cut short approximately 2 cm.

Various steps of Roeder’s knot (Images)

Steps A to D
  Steps A to D

Steps E to J
  Steps E to J

Steps K to P
  Steps K to P

Steps Q to U
  Steps Q to U

Properly configured Roeder's knot loop diameter should be approximately 4 cm. A large size loop is difficult to manipulate inside the abdominal cavity and a very short loop is difficult to reach up to the base of the structure which is to be tied.

Roeder's knot can be remembered as 1:3:1

•    One hitch
•    Three winds
•    One locking hitch.

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