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Ann R Coll Surg Engl. 2009 July; 91(5): 440.
PMCID: PMC2758461
Technical Notes and Tips
Bruce Campbell, Section Editor

Extracorporeal Melzner Knot for a Wide Cystic Duct in Laparoscopic Cholecystectomy

Figure 1

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Stepwise illustration of tying an extracorporeal Melzner knot onto the cystic duct with a braided absorbable suture (Vicryl 2-O™: Ethicon, Bankhead Ave, Edinburgh EH11 4HE, UK). GB, gall bladder; CD, cystic duct.

In the case of a wide cystic duct, where laparoscopic clips would not occlude the full width, an extracorporeal slip knot would be appropriate. Other advantages of applying this knot include less expense and eliminating the risk of catching the common bile duct with the end of the clips. In step 1, interpose the stem of instrument A above the suture to prevent ‘cheese wiring’ the cystic duct on pulling through. Before step 4, remember to ‘snug down’ the throws that have been previously performed. Finally, push the knot down using a knot pusher as in step 6. Do not pull up like a lasso as it would saw through and tear the tissue.

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England