The 4-S modification of the Roeder knot: How to tie it

BACKGROUND: The 4-S modification of the Roeder knot may be tied laparoscopically as a single-throw knot. TECHNIQUE: It is tied by adding a fourth wrap around the suture loop and securing the loop in place with a square knot rather than a single half-hitch. EXPERIENCE: We have used this knot in laparoscopic surgeries for more than 2 years and have not observed knot slippage. CONCLUSION: This modification results in a knot comparable in strength to the strongest laparoscopic multiple-throw square knots.