The method of tying shown here differs from the conventional instrument tie by initially passing the suture from one instrument to the opposite instrument to set up the knot, and avoids pulling the wrapped instrument out of the loop in reaching for the free end. This method is also used for intracorporeal laparoscopic knot tying because of its efficiency in constrained space. The needle end (on the left here as for a right-handed needle pass) is lifted with a curved forceps with the points down.
The right-hand instrument reaches across and grasps the top of the C-loop with the points of the instrument down. Keeping the convex side of the instrument toward the convex side of the suture opens up the loop and facilitates wrapping.
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