1) Cutting suture 75-90cm with Endoski needle which is proximal 2/3rd straight & distal 1/3rd curved.
2) Insert Maryland in the reducer.
3) Hold the suture with Maryland at the tail end & pull it out through the reducer & then hold it near the needle and hide it in the reducer.
4)Insert the Maryland with the reducer into the abdomen.
5) Drop the needle over the tissue in such a way that the tip should be in the left & the tail in the right side.
6) Align the needle by the following 3 techniques:
a) Pressing the needle by the upper jaw of the needle holder at the junction of 1/3rd & 2/3rd.
b) Holding the needle by the left hand at the curvature & pulling the suture up near the needle by the right hand.
c) Hang the needle by the left hand like a pendulum & go with the open jaw of the needle holder keeping the moving jaw to the left & dragging it to the right.
7) Stabilize the tissue by the left hand & take a bite by keeping the needle at 90 degree angle to the tissue & rotating the tip of the needle to bring it to the other side.
8) Bring the tip of the needle 1/3rd out& catch it with the left instrument, keeping the convex end towards the tissue.
9) Guard the tissue by the needle holder, keeping the concave part of the instrument towards the tissue & pulling the needle by the left hand instrument.
Feed the suture 4 times inside abdomen .
10) Hold the suture by the needle holder as soon as the needle is out.
11) The configuration of WESTON KNOT is 1-1-1.
12) WESTON KNOT is a self locking sliding knot, which has one hitch, one reverse hitch & one final wrap and lock.
The Step of Weston Knot are:
The Step of Weston Knot are:
Step 1: The index finger of the assistant may be used to make Weston knot. The left hand should be used to hold the short limb and the right hand long limb of thread.
Step 2: The short limb of the thread is crossed over the long limb.
Step 3: The intersection point of thread should be pinched by left hand index finger and thumb. At the time of making intersection, surgeon should keep sufficient length of short limb, to make it comfortably. It is important to remember that left hand is used only to hold the intersection point while the right hand will make the necessary hitches and loops.
Step 4:The short limb is passed between the thread upward.
Step 5:The short limb should be pulled from up by right hand to make first hitch.
Step 6:The short limb is placed towards the left side and is passed between the two limb upward to make a reverse hitch.
Step 7:The short limb should encircle the thread from below upward and should be put in the first loop to lock it.
13) Now hide the knot in the reducer with or without Maryland & push the knot sliding downwards to the desired place where you want to tie by keeping the suture in the left hand t & pulling the suture with the right hand.
14) After tightening the knot, you can take a final square knot to secure.
15) Introduce the scissors from the right port and cut the suture.
16) You can again reuse the same suture needle to tie another knot.
17) Weston knot is used in gynecological surgeries & also in arthroscopic surgeries. It can be used in situations where suture slides smoothly & freely through tissue & the anchoring device.
Advantages of Weston knot:
a) It is a relatively easy knot which can be tied outside, can slip easily into place & tightly secured.
b) It locks readily & is not bulky.
c) No knot pusher needed.
e) The suture needle is maintained, so it can be re used for taking another bite.