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Introduction of barbed sutures has made continuous MIS suturing easy, fast, and safe. The novice MIS surgeon should not attempt continuous suturing with smooth suture in these authors' opinion. For suturing with barbed sutures, it is important to follow the manufacturer's instructions on strength and how to anchor the start of the running suture.

Extracorporeal knot tying is indicated when the maneuvring space is insufficient for intracorporeal suturing. Another indication is if the tension on the defect exceeds what an intracorporeal surgeon's throw can withstand because a high‐strength jamming knot tied extracorporeally is stronger. In contrast to using a ligature loop, extracorporeal knot tying is also useful for placing ligatures without the need to divide the structure before ligation. The concept of extracorporeal knot tying is depicted in ssss1.

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The knot type used depends on the indication for using an extracorporeal knot. If paucity of intracorporeal space is the main reason, regular square throws can be tied extracorporeally, with each throw being cinched with a knot pusher while both suture ends are secured outside the body. These throws should be applied with proper one‐handed technique to avoid that identical half hitches are placed, resulting in granny knots. However, if a stronger starting knot is needed to overcome tension, a more complex slip knot is needed. With few exceptions, these slip knots need additional throws for security if they are to be placed in tissues under tension.