Home-made Knot-pusher for Extracorporeal Knot-tying

Abstract

The Clarke ligator (knot-pusher) has proved to be useful for laparoscopic suturing. Recent rediscovery of the instrument and its application has markedly simplified laparoscopic suturing and extracorporeal knot-tying. A home-made knot-pusher was made from solid stainless steel rod 4.5 mm in diameter, 350 mm in length. The opened circular tip was made with ordinary tools. All edges of the tip were smoothed and polished to avoid trauma to suture material and pelvic organs. The home-made knotpusher was tested with more than 100 knots on a pelvictrainer. The knots were secured without trauma to suture material. Thereafter, extracorporeal knot-tying was successful in 14 pelviscopic surgical procedures. We have found that the home-made knot-pusher can be easily made at a much lower cost and is convenient to use. Since high cost and length of operation time are the major disadvantages of laparoscopic surgery, a home-made laparoscopic instrument can lower the cost of surgery, without increasing operation time. Tip configuration should be further modified to make it even more suitable for laparoscopic surgery. (Thai J Obstet Gynaecol 1994;6:33-36.)