The pretied suture loop with slip knot (Endo LoopTM, USSC) is a unique instrument that is used exclusively in laparoscopic surgery (Figure 2.14). The loops are used to obtain primary hemostasis when the vessel or vascular pedicle is divided and grasped. The loops are useful to secure unexpected bleeding after transection, where electrosurgical methods or clips are difficult to apply. After the bleeder is identified and secured with an atraumatic grasper, a second grasper is introduced from the other port and passed through the loop. The first grasper is then gently released, and the second grasper grasps the bleeding point. The loop is snugged down over the shaft of the instrument, securing the bleeder.
Another usage of this device is to secure the stump in laparoscopic appendectomy. After securing the stump, the device can be used as an effective retracting tool unless its string is cut. Various suture materials are available. We generally use a synthetic absorbable material such as
Vicryl™ (Ethicon, Somerville, NJ), or Polysorb™ (USSC), or PDS-II™ (Ethicon).
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