the technique described provides extracorporeal control of one limb of the suture and has the advantage of continuous tension application on both ends of the thread during knot formation . it is easy to learn , fast to perform , and no new equipment is used . the needle end is advanced through the trocar , and the free end is firmly grasped extracorporeally by the assistant . the needle is passed through the tissues to be sutured and held with the right needle holder . the left - hand instrument holds the filament about 5 cm proximal to the needle , thus resulting in a triangle formation , the apex of it being presented by the tissues to be sutured and the base by the segment of the filament between the left instrument and the needle holder ( figure 1 ) . the needle is rotated around the free end of the filament , which is aligned and held in place by external traction ( figures 2 and 3 ) . as many turns as desired are thrown choosing the appropriate direction : for clockwise throws , the needle is grasped proximally and for opposite throws distally . the surgeon prepares to rotate the needle around the limb of the suture for a first time . accurate and safe tissue suturing is essential for advanced laparoscopic surgery . during the last decade , suturing devices such as clip applicators , staplers , and endo - loops have been developed . extracorporeal knots are easy to perform and are usually created by multiple throws that are advanced intracorporeally with a knot pusher . most important , tension can not be maintained while throwing turns , and the tying instruments before the next throw release the ends of the filament . on the other hand , sequential throw formation in opposite directions is technically demanding , resulting in an unsecured sliding sequence instead of a square knot . another problem is tissue exposure to unnecessary manipulation and traction from pulling long lengths of suture through the needle track and pushing the knot into position . intracorporeal knots seem to deal better with the last issue , and they have the advantage of focusing on the operative field during creation . however , a considerable degree of virtuosity is required , and these knots are not available as an option to occasional laparoscopists . on the other hand , the main problem of preserving ligature tension while forming the knot remains to be settled . even though the technique is an intracorporeal one , continuous tension is guaranteed by providing extracorporeal control of one limb of the suture , thus allowing the manipulation of the needle end with both instruments . winding sequential throws in both directions the procedure necessitates the presence of a curved needle and can be used for ligating tissues that must be securely approximated , as in gastric banding and nissen fundoplication . the greek term for intracorporeal knot  is easy to learn and is secure and therefore presents an option not only to the laparoscopic surgeons but to other surgeons as well .