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For braided suture, the knot is complete with a double and two single throws. However, for monofilament suture, two or three more single throws are required for knot security.

Paying attention to in which direction one is wrapping the suture material around the instrument needs to become second nature. Alternating between clockwise and counterclockwise wrappings (ssss1) ensures that square knots are formed.

This technique entails several transfers of the needle between instruments. It is therefore slightly slower than the Rosser technique described above. However, benefits include tightening of the knot without crossing instruments. Needle transfer also encourages regrasping close to the knot for tightening. These features minimize the risk of inadvertently applying inadequate tension on the knot. In fact, the authors prefer this technique for ligation purpose or for sutures placed in tissues under tension. This technique also differs from the earlier one in that the throws are wrapped around the ipsilateral instrument (i.e., the throws are alternately made around the left and the right instrument). Traditionally, this suturing is performed with two needle drivers, with a right and a left curved jaw, respectively.