Slip-knot suspension technique: a fail-safe microanastomosis for small-caliber vessels.

The most common technical error associated with microvascular anastomotic failure is accidentally snagging the opposite wall and including it in the stitch, thereby reducing the vessel lumen diameter or occluding it altogether. A simple, safe microsuturing technique is described that combines the use of the slip-knot and the suspension technique in a procedure that allows direct visual inspection of suture placement from first to last stitch. This technique is applicable to end-to-end and end-to-side microvascular anastomoses, for thick-walled ducts such as the vas deferens and the fallopian tube, and in laparoscopic suturing.