The challenge of suturing intra-abdominally is not as great as the process needed to tie and tighten the surgical knot.The knot-tying process can be achieved within or outside of the abdominal compartment.One technique uses laparoscopic grasping forceps and a laparoscopic needle holder only,and another uses the same instruments plus two obturator sleeves to push,slide,and tighten the knot into place.When sutures are tied and knotted during an open procedure,the surgeon may tie the knot with gloved fingers,called a one- or two-handed tie,or wrap the suture around the tip of a needle holder and grasp the other end of the suture to pull it through the wrapped coils;this is called an instrument tie.The intracorporeal suture technique uses the suture-tying process analogous to the:

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Extracorporeal Sutures:Tissue can be approximated intra-abdominally when the knot is tied extracorporeally (i.e.,outside the body).To accomplish this,endoscopic swaged sutures are used.The suture is grasped proximally to the needle,and both are inserted through one of the obturator sleeves into the abdomen.The needle is held with the grasper or laparoscopic needle holder and driven through the desired tissue.A second grasper or needle holder inserted through a second obturator sleeve is used to assist.The needled end of the suture is pulled through the tissue and out through the sleeve.The needle is removed,and the surgeon's fingers are used to tie a knot extracorporeally.The knot is advanced down the sleeve and onto the tissue.The suture is cut with laparoscopic scissors.The three types of knots tied extracorporeally are the slip knot,the fisherman's knot,and the surgeon's knot.
Intracorporeal Sutures:A suture ligature also can be passed through the obturator sleeve to be tied while it is inside the body.The tissue is approximated in the same fashion but tied intracorporeally (i.e.,inside the abdomen)using grasping forceps or laparoscopic needle holders.

The Challenge of Suturing Intra-Abdominally Is Not as Great as the Process