This video demonstrate Laparoscopic Tumble Square Knot. Laparoscopic Tumble Square Knot is the only knots that can be used when the suture does not slide freely through the tissue and anchoring device. Laparoscopic Tumble Square Knot configurations also theoretically avoid suture damage from abrasion and tissue damage during sliding. The major disadvantage of static knots is the propensity of the loop to loosen before the second half-hitch is seated to the point that it provisionally “locks” the knot. One method of minimizing this effect is by using a maryland to push the square knot on which one limb is tumbled which holds the tissue loop tight as it advances sequential half-hitches.