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ssss1 Suture assist devices (from top left to bottom right): Koeckerling knot tier, introducer sleeve, and EndoLoop ligature.

Source: © 2014 Photo courtesy of KARL STORZ SE & CO, KG.

The Endo‐Loop Ligature (Karl Storz GmbH) (see ssss1) was developed for use over free vascular pedicles. It consists of a pretied loop of suture with a Roeder knot loaded into a single‐use plastic cannula. After the loop is placed around the desired tissue, the cannula is snapped at a prescored line. The most distal end is used as a handle to tension the suture while the rest of the cannula serves as a knot pusher to close the ligature around the pedicle. After it is tightened, the suture can be cut and the remaining suture, and cannulas are removed.

All instrument packs for MIS should include traditional open surgical instruments for the securing of drapes and initial port entry. Additionally, it is wise to always be prepared to convert to an open procedure when warranted. To that end, a general surgery pack containing at least drapes large enough to cover the patient and operating table; sufficient towel clamps to secure the drapes to the patient; a #3 scalpel handle; a pair each of Brown‐Adson and DeBakey thumb forceps; several curved mosquito and either Crile or Kelly hemostatic forceps; Metzenbaum, Mayo, and suture scissors; needle holders; a saline bowl; and 4 × 4 x‐ray detectable gauzes are needed.