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Ti-Knot (TK) Fastener

The Ti-Knot (TK; LSI Solutions) is a titanium suture fastener deployed by a hand-held applicator to secure compatible suture without a hand-tied knot. Each TK QUICK LOAD carries one fastener for loading into the applicator's 5-mm shaft. The quick load's wire snare threads both suture ends through the loaded fastener, which the applicator then crimps while trimming the tails.[1] It is used through the JNW UrTrac sheath in a published endoscopic-urethroplasty technique; the fastener is left at the repair initially and may later pass.[1][2]

Design​

  • 5-mm diameter, 31-cm applicator and separate, single-fastener TK QUICK LOAD with a hollow mushroom-shaped titanium sleeve and target/wire snare.[1]
  • Integrated crimp-and-cut mechanism. Load the compatible suture as directed, tension without overtightening, squeeze and hold to crimp and cut, release fully, and inspect the fastener and cut tails.[1]
  • The sterile device is single-patient use and is not a one-fastener-only handpiece: the IFU permits up to 12 firings with specified quick loads. Do not resterilize or use unapproved suture; follow the supplied model's IFU.[1]

Use in TUITMR Endoscopic Urethroplasty​

In Dash and Warner's TUITMR technique, after the RD180 places preloaded 2-0 Monoglide through bladder mucosa (ideally proximal to the resection bed) and corresponding distal urethral mucosa, limiting scar-bed bites:[2]

  1. Load one compatible TK QUICK LOAD using its snare, then route the suture tails through the applicator according to the IFU.[1]
  2. Advance the loaded Ti-Knot through the UrTrac under visualization, with its distal tip exposed in the bladder. In Dash and Warner's technique, tension the suture externally while drawing the sheath back to the distal stitch, watching the mucosa advance when visible; seat the fastener without excessive tension.[1][2]
  3. Squeeze and hold to crimp and cut, then release the lever completely. In Dash and Warner's technique, rotate the released handpiece from 3 to 9 o'clock several times to confirm that the fastener is free before withdrawal. Inspect the fastener and cut tails.[1][2]

Practical Rationale and Limits​

The fastener avoids hand-tied intracorporeal knots in a narrow corridor, but correct loading, controlled tension, complete firing, and visual confirmation are still required.[1][2]

Known Complications​

Exposed retained TK fasteners or suture in urine may calcify and require endoscopic removal. Dash and Warner describe a four-month cystoscopy in their TUITMR practice to check whether clips have passed and remove retained clips if necessary. The manufacturer also warns about foreign material in the urinary tract.[1][2]

Other Applications​

The platform is marketed for suture fastening in minimally invasive soft-tissue surgery. Verify the particular device and suture combination and operative indication against its IFU.[1]

References​

1. LSI Solutions. TI-KNOT product and product insert, P/N 030639N.

2. Dash ME, Warner JN. Detailed surgical technique for endoscopic urethroplasty. Transl Androl Urol. 2025.

See also: JNW UrTrac Sheath, RD180 Suturing Device, Barbed Sutures (analogous knotless-closure principle).