Getting by with less — the “frugal tie”

Getting by with less — the “frugal tie”

Can J Surg 2014;57(6):412-16 | PDF

Jacques Rizkallah, MD; John M. Rothschild, MD; Derek V. Exner, MD, MPH

From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alta.


The ability to tie surgical knots efficiently and effectively is an essential surgical skill for medical procedures, especially pacemaker implantation. Device generators and their leads need to be safely anchored with sutures during implantation to prevent dislodgement and inadequate packaging in the pacemaker pocket. With most knot tying techniques, a generous amount of suture slack is required. We introduce a new technique that is a variation of the 2-handed surgical square knot and the 1-handed surgeon’s knot that allows one to finish or tie a knot when left with little slack.

Completed poster presentations at the Libin Research Day, Apr. 8, 2014, and at the Cardiostim EHRA Europace conference, June 18–21, 2014.

Accepted for publication Apr. 3, 2014

Acknowledgements: Dr. Exner is Canada Research Chair in Cardiovascular Clinical Trials. Images provided by Joseph Rizkallah Photography.

Competing interests: None declared.

Contributions: All the authors read, approved, and contributed to the manuscript.

DOI: 10.1503/cjs.003814

Correspondence to: D.V. Exner, 3280 Hospital Dr. NW, Rm GE 63, Calgary, AB, T2N 4Z6;