Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches

Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number throws, an opposite similar rotation compared with the previous one, and for whether they sliding (s) blocking (b). Opposite results in (more secure) symmetric knots, asymmetric (a) changing active passive ends has same effect as rotation. Loop security is force to keep tissue together after a first half-knot half-hitches. With polyfilament sutures, H2, H3, SSs, SSsSsSs have loop 10, 18, 28, 48 Newton (N), respectively. monofilament only 7, 16, 25 N. Since many can reorganize, definition knot at which opens suture breaks should be replaced clinically more relevant percentage dangerous insecure knots. Secure sutures require minimum four five but risk destabilization high. two symmetric+4 secure. In conclusion, gynecology open laparoscopic surgery, half-hitch recommended because mandatory adding flexibility less destabilization.