This video demonstrate Laparoscopic Tayside Knot. This is an extracorporeal knot can be used to ligate tubular structure. The Tayside knot is suitable for use with all braided sutures (2/0 or stronger) as well as dacron. It is used with Dacron for ligation of vessels such as the azygous vein, splenic artery/vein or the inferior mesenteric artery/vein. A variety of slipknots are used by various professions and in certain leisure activities. Some of these have been adapted for use in endoscopic surgery. The holding strength of individual types of slipknots is influenced by a number of factors including the ligature material used and its caliber. Thus a slipknot may be secure when tied in catgut but unsafe with other materials. In addition, some slipknots are difficult to tie or jam lock too easily for reliable placement by push rod before locking.

Laparoscopic surgery has transformed modern surgical practice by allowing complex procedures through minimal incisions, resulting in reduced pain, quicker recovery, and better cosmetic outcomes. A core skill in advanced laparoscopic techniques is knot tying, which ensures secure ligation of tissues and vessels inside the abdomen. Among the various methods available, the Tayside Knot stands out as a reliable and efficient extracorporeal knotting technique. Its demonstration by renowned laparoscopic surgeon Dr. R. K. Mishra provides valuable insights for surgeons learning or refining minimally invasive skills. 

About Dr. R. K. Mishra

Dr. Ramesh Kumar Mishra is a globally recognized expert in laparoscopic and minimal access surgery. He is the founder and director of the World Laparoscopy Hospital and World Laparoscopy Training Institute, institutions dedicated to advancing laparoscopic surgical education worldwide. Through decades of teaching and surgical practice, Dr. Mishra has trained thousands of surgeons across continents in advanced laparoscopic techniques. 
Laparoscopic Video

What Is the Tayside Knot?

The Tayside Knot is an extracorporeal slip knot used widely in laparoscopic surgery for securing tubular structures such as ducts and vessels. Constructed outside the abdominal cavity, it is advanced to the surgical site using a knot pusher and then tightened securely at the desired location. This technique combines simplicity with high tensile strength, making it particularly useful in procedures where conventional mechanical devices (like clips or staplers) are impractical, costly, or unavailable. 

Key characteristics of the Tayside Knot include:

High knot security with a self-locking configuration.

Effective ligation of critical structures such as the cystic duct, appendix base, or vascular pedicles.

Adaptability in various laparoscopic procedures.

Cost efficiency, especially in resource-limited settings. 

The Demonstration: Technique and Teaching

In Dr. Mishra’s demonstration, the focus is on practical, step-by-step instruction that both novice and experienced laparoscopic surgeons can follow. Key points from the demonstration include: 

1. Instrument Preparation

Dr. Mishra begins by outlining the necessary instruments and correct setup for extracorporeal knot tying, ensuring smooth passage of the knot into the abdomen.

2. Constructing the Knot

The video guides trainees through the sequential construction of the Tayside Knot using standard suture material, emphasizing symmetrical throws and proper hand movement to avoid slippage.

3. Advancing the Knot

Once formed, the knot is delivered into the operative field using a knot pusher, requiring careful navigation through the laparoscopic ports.

4. Securing the Knot

The knot is then tightened precisely at the ligation site, with tips on maintaining tissue approximation and avoiding undue tension.

5. Clinical Utility

Dr. Mishra illustrates the use of the Tayside Knot in common procedures like cholecystectomy (gallbladder removal), appendectomy, and gynecological surgeries, demonstrating its versatility.

Advantages in Clinical Practice

The Tayside Knot offers several advantages:

Reliable and secure ligation, reducing the risk of postoperative bleeding or bile leakage.

Minimally traumatic to tissues compared with some device-based ligation methods.

Economical, especially beneficial in settings where disposable devices may be cost-prohibitive.

Useful in tight spaces where intracorporeal suturing may be technically challenging. 

These attributes make the technique a valuable addition to the surgical repertoire, particularly in emergency cases or resource-limited environments.

Conclusion

The Laparoscopic Tayside Knot demonstration by Dr. R. K. Mishra is an excellent educational resource highlighting an essential skill in minimal access surgery. With clear instruction on knot construction, advancement, and application, the technique enhances the safety and effectiveness of laparoscopic procedures. For surgeons seeking to improve their suturing and knot-tying competence, mastering the Tayside Knot under expert guidance is an indispensable step toward greater procedural confidence and improved patient outcomes.