External component (starter knot)
1. Take cutting suture (40cm long) with Endoski needle
2. Make a loop with the shorter limb over the longer limb.
3. Go from below the loop and pull the Non Needle end( Longer Limb) to create loop within a loop and than tighten it
4. Repeat it, to form another loop within the loop.
5. Insert the Maryland through reducer
6. Hold the both limbs of the loop with the Maryland, hide it in the reducer and insert into abdominal cavity.
Internal component
7. Insert needle holder through another cannula.
8. Hold the needle at the junction of anterior 2/3rd and posterior 1/3rd.
9. Take the first bite (at the angle of the cut peritoneum/ tissue) both cut edges.
10. Pull the needle end till the starter knot touches one of the cut edge.
11. Carefully pass the needle holder through the loop and hold the suture near the needle and pull it through the loop.
12. Tighten it by pulling the needle end of the suture. It gets locked.
13. Then start continuous suturing by making C and taking bites for interlocking. Can do this step without interlocking.
Termination with Aberdeen’s
14. On the last bite, do not form a C ; without tightening it leave it loose to form a loop.
15. Pass the needle holder through the loop and hold the suture at the exit point of the cut edge and pull the non needle end till its get tighten and the other loop is form. Do not pull the needle out. Again go through the loop and pull the non needle end.
16. Repeat this again and now pull out the needle through the loop and tighten it.
17. Insert scissors and cut the suture end 1cm.
18. Remove the needle with Maryland.