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It is often easier for an endoscopic surgeon who is starting to place endoscopic sutures to tie knots extracorporeally. Extracorporeal knot tying can be performed using standard suture material or using pretied loop sutures, such as the Endo‐Loop Ligature. With standard suture, a single half‐hitch, double half‐hitch (i.e. surgeon's throw), or modified Roeder knot (for details, see ssss1) is created outside of the body and then is pushed through the cannula using a knot pusher. A knot pusher (Ethicon Endo‐Surgery) is a plastic tube with a conical end through which the suture ends pass. The knot pusher then is used to slide the knot into the body cavity by pushing down on the knot while simultaneously pulling up on the suture ends. After placement, a half‐hitch knot can be corrected to an overhand throw. Koeckerling Knot Tiers (Karl Storz GmbH, Tuttlingen, Germany) (see ssss1) are 5‐mm instruments on long shafts with a notch and hole at the end; they serve the same purpose as a knot pusher. Endoscopic Babcock forceps can also be used to advance and secure an extracorporeal knot.