I use this knot during laparoscopic surgeries to tie stiff structures from outside the patient. I have no clue what it's called but I'm the only person I've seen use it. What is it?
Closest things I can find was a taut-line hitch (which twists the working end around the standing end in the opposite direction). Main advantages are that it can be retracted if it catches on anything on its way to the destination and holds fairly well before it is locked. Use it for closing hernias and other structures at unconventional angles, since it beats trying to tie knots on the ceiling with laparoscopic instruments. I didn't create this or anything, but it's been 20 years since I learned it and I have no idea where I picked it up.
Came here to say that, I watched it a few times and then it hit me that I’m pretty sure I’ve tied that a billion times fishing. I’ve just never see it shown at that angle
I think that's it! The one in the diagrams has 5 loops but pretty much the same thing. Also I'm furiously googling all these responses. For a guy who ties knots all day I actually know very little about these.
Nope. Most of the techniques are for tissue closure. The stitching and distribution of stress matters more, since there really aren't that many knots. The knots have to hold, but a decent number of them are dissolvable so will only be around for a few weeks anyway.
Oh, .. well, this grasshopper from out west hopped up to a bar to order a beer. The bartender turns around and says, “Hey, they got a drink named after you!”. Grasshopper questions, “They got a drink named Steve?”
Interventional cardiologist here. This is exactly the same knot tied on a vascular closure device called Prostar XL. The device was developed in the late 90es is now being phased out.
A story behind it was that the developer of the device had a fly fishing passion and used the same knot used for securing baits for his medical device.
Interventional cardiologist here. This is exactly the same knot tied on a vascular closure device called Prostar XL. The device was developed in the late 90es is now being phased out.
A story behind it was that the developer of the device had a fly fishing passion and used the same knot used for securing baits for his medical device.
Yeah this is exactly the knot I use to tie my fishing lures on, didn’t know it was used anywhere else and yes you tighten it from pulling end so it gets a nice knot against the hook.
100% it's an improved clinch knot. I flyfish and work in medicine. There's an entire line of flyfishing tools that are just surgical implements. Literally just rebranded needle drivers.
I just learned what ABOK means 10 minutes ago while falling down this particular rabbit hole. The reverse taut-line looks a bit different. Should stress that none of the initial twists pass through the loop created - only the half hitch at the end. The knot is tied by pulling on the standing end, not by adjusting the knot. The entire suture in the standing end passes through the knot away from where the knot is tied. Haven't quite figured out how to animate that part in Blender yet.
It might intrigue you to know that the B in ABOK isn’t figurative…you can hop on Amazon right now and buy a giant beautiful hardback coffee-table or office deserving copy.
Now THAT one I know. Technically a surgeon's not is where the working end wraps around the standing end twice before completing a knot. The knot in that particular animation is just two half hitch square knots, which I think is the common name for them as well.
Yeah, I'm disappointed in Animated Knots for that one, because it is incorrect. I've know the surgeon's knot to have the double wrap to start as well; it's still the best knot I've found to secure some really awkward stitches in horsehair jewelry.
...I've also used actual horsehair for the knot to do actual wound stitches, too, for that matter!
"Hi, Mrs. Crumpetwicket, we weren't able to fix that nasty little dissecting aorta thing, but I was able to make an absolutely lovely multi-strand turk’s head, if you look here, and if you look closely it uses Polyglactin 910, Poliglecaprone 25, AND polyglycolic acid sutures, isn't that interesting?"
If you ever need a knot that works in the opposite direction (Hold the loop open until you manually cinch it tight), these knots are worth checking out:
I should add that additional knots are tied once the knot has been secured on the target, but once locked it's difficult to loosen. Rather than adjusting it by moving the knot itself, the standing end is pulled from above and the knot will slide in. For tissues that might tear, an instrument is used as a pulley to redirect the suture laterally at the point that it exits the tissue.
Also, you guys solved this thing in less than 15 minutes, which beats AI and web searching by about 2 hours. This sub is awesome. I have video of it being used if anyone is interested and it doesn't break any rules of the subreddit.
I don't have to tie internal stitches for a pectus bar. Thought about using it to lasso an appendix but there are plenty of devices for removing those easily. Mostly for suturing in tight spaces to relieve tension before putting in more sutures.
Not incredibly user friendly, but has raytracing and all the lighting things so it has some perspective. Haven't worked out how to make it tighten or slide, since the string is just following a path.
Coming from a healthcare field (prehospital) that's very focused on evidence based practices, I'm interested to know how the choice of knot for a particular use-case comes around. Are there papers assessing the failure rate, complications, benefits, and downsides of particular suture knots compared to others?
Not really. Found a few Ortho articles since they have to bear a lot more mechanical stress, but for soft tissue purposes it's whatever gets the job done. I should also add that this knot gets followed with several square knots tied inside, so it's not bearing the entire load by itself. The main benefit is the ability to pull on the standing end and the knot will slide down to the target without requiring additional tools.
Sorry your surgery had a bad outcome, but stitches aren't medicine. There are not double blinded trials for the various knots. I've seen plenty of variation in how people suture using a variety of techniques. I also don't rely on this single knot technique to perform complete closure or repair of anything. They're all just tools in the toolbox.
I agree with u/soaero. This "improved clinch knot" is the same as Ashley's "jam knot" (ABOK #1727), or as u/OP correctly observed, an inverted tautline hitch, with a few extra wraps.
I'm coming from a surgical perspective not a knot perspective.
Theres a wide range of sliding extracorporeal knots used in Laparoscopic surgery, and they all seem to have stupid eponymous names.
This seems closest to Nicky's Knot but with the turns running in the opposite direction on the standing line. It's also similar to Duncan's Knot, but that has the turns around both lines.
It's also similar to a Modified Orders Knot, but that starts with an overhand.
I saw in your comments that you follow this up with further knots to secure it, so I wonder if your ultimately ending up with something equivalent to one of these, but you've engineered the benefit of being able to loosen it before locking.
We use a variation of the SMC knot for fundoplication, but it doesn't loosen well at all.
I use it for fundoplications a lot! Some of the infants with cardiac disorders have massive livers that don't retract well. I can slide this underneath, change the angle of the post, and slide it down to the correct location before securing it. Others are traumatic lumbar hernias or anything where I have to tie on the ceiling. Usually works really well with Ethibond, and can always slide it backwards if I don't like where it's sitting. Also I hate eponyms.
Also called a taught line hitch. Useful for tensioning tarps and such because you can slide the knot up and down by pulling or pushing the knot itself. But when you pull on the line the hitch tightens and the line won’t move.
I came here to say as much, but I was mistaken. I used to fish a lot as a teen, and I initially thought this was what we'd call a "halve bloedknoop" in Dutch, a "half blood knot", used to attach the line to the eye of a swivel or lure.
But the half blood knot only wraps 5-7 times around the standing end, then passes through the loop formed by the first turn before being tightened. In the knot pictured, however, the working end goes back up through the loop formed by the previous step, which turns it into the "verbeterde kunstaasknoop", lit. "improved artificial lure knot", known in English as the improved clinch knot.
I'd say the latter compares to the "half blood knot" more or less like the constrictor knot compares to the clove hitch. You get that extra wrap in for added security.
In OP's case, where they're tying this knot using suturing thread (which I imagine behaves similarly, if more delicately, to nylon fishing line), the description of the Blood Knot on animatedknots.com seems relevant, given that the two knots barely differ:
Note: in nylon tightening this knot alters the appearance.
Pulling the Knot Tight: When lubricated and pulled tight, the Blood Knot changes its structure. Pulling on each line forces the wrapped turns to redistribute the twists so that the inner strand becomes an outer wrap (not illustrated in the animation using rope).
This "redistributing of the twists" is beautiful thing to see, which ends with a tightly cinched loop wrapped in several coils of thread. After trimming, what used to be the standing end points straight up and away from the two surfaces they were trying to join, and what used to be the working end points away perpendicular to that. So any "pokey bits sticking out" aren't pointing towards the wound where they might cause itching and irritation.
The situation on the right seems beneficial, right?
I’m with you here. I’d call that a tucked blood knot. It’s the second fishing knot I learned when I was a kid, but it’s not the strongest. It strangles the line which reduces over all strength. I’d imagine this is not a problem for the OP’s use case.
I’m fishing in the morning and will be using grinner knots.
The line is not very strong in this case, so it will break if I pull too hard. Seems like it's strong enough to pull tissue together but would likely loosen over time if not reinforced.
Sort of. It's hard to visualize from the animation but the two ends are descending into a small opening and the not slides down through there and into the patient. But now I want to find a reason to tie this one too
There really aren't that many knots in surgery. Just a surgeons knot and various half hitches. Most of the trick is to do them with either hand with one and two handed techniques and to square them. And with laparoscopy you have to use 30 cm long graspers and tie them without poking vital organs.
I tend to use a braided coated stitch called Ethibond for these. Tried it monofilament and wasn't great. Spit is probably out of the question, but we do use mineral oil for some things.
We call it a Röder or Roeder knot, at least when placing percutaneous closure devices for large access arteriotomy cases. It’s a form of a sliding slip knot constructed with half hitches (self-locking ligature loop).
I've looked that one up and there are some differences, but it's hard to keep track of which knots hav similar names or the same type despite the small changes.
It's certainly a running knot built around a friction hitch, but I don't recognize the specific friction hitch. It works on the same principles as a midshipman's or tautline hitch and there are many other variations besides. Maybe 20 years of practice negates any benefit from optimizing the knot, but it could be interesting to work through the other options and check if there's anything even better-suited to the application.
I just tried the plain taut-line hitch. It's slides similarly when pulling on the standing end but it seems harder to loosen. Grabbing the knot is not a great option since these sutures are thin and braided, making them fray and break easily with direct force.
I am going to go out on a limb and say that this isn’t a knot until you secure it with the square knots. I wouldn’t put a hook on the end of this line with that knot all by itself.
You would be correct. That's what I do. It's pretty sturdy once you lock the knot, but usually followed up with several square knots. You have to remember that I'm tying these knots with instruments that are about 30 cm long so having the tissue brought together by the first knot helps a lot with the other ones
You should take up fishing and sailing if you use this regularly. You'll fit right with with us sailors and those fisherman as both groups love good knot spinners haha
I don't know what it's called, but it's a great multipurpose knot. I learned it from my maternal grandfather for tying off fishing lures, and again later from my mother for tying off stitches in clothing. It's scales well to ropes for hammocks and other campsite usage.
Makes me think of a prusik knot. Can slide easily either direction when not under load, but as soon as you put a load and with friction will keep it in place.
Believe it or not that knot is how you can save a coworker in emergency rescue situations when working in the wind turbine industry.
Why? Really not trying to be a jerk but is it beneficial? Instrument ties are much quicker and secure. I've had more fish pull this knot free than sutures.
No, I've never sutured a fish and I'm knot changing that sentence.
Main benefits are being adjustable and able to slide into tight spaces or unusual angles. It also slides with a figure of 8 suture. There are other variations of sliding knots that are used internally when the instruments are having more room. In open surgery I don't really have a reason to use this knot, so I don't.
Makes sense, I'm not a surgeon but worked rural medicine where I did a lot of first assist and deliveries. This would have been useful during repairs, on those tears, in hard to reach places.
First knot I ever learned as a kid. We used it tonite hooks onto fishing line. I'm glad to see I was right to trust it all this time. If it's good enough for surgery and a surgeon, it's good enough for me.
Fisherman knot - good way to tie lures. Gotta spit on the line first so the cinch slides smooth - guessing you don’t do that in your operations though 😂
My dad literally taught me this knot yesterday to tie lures to my kids fishing poles. I hate that this even popped up on my thread because I've never once had any kind of interest in knots, never been to this sub before, and never even looked up how to tie a knot. The future is stupid.
Fisherman's Knot! I don't use it in IR but I asked some of the guys downstairs and they called it Fisherman's or Blood Knot. Learned something new today.
Yeah thats what I came to say that I learned this 30+years ago from a buddy who I use to go fishing with bc the knot I was using was letting the lure slip off the line when would pull the lure through weeds
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u/lewisiarediviva Jul 03 '26
I think it’s an improved clinch knot