Skip to main content

Ti-Knot (TK) Fastener

The Ti-Knot — often abbreviated TK in endoscopic-urethroplasty literature — is a titanium suture fastener (LSI Solutions) that secures suture tails without the need for hand-tied knots. It functions as a self-crimping titanium ring that is applied to a pair of suture tails, locks them in place, and cuts the excess. The knot-free equivalent of a surgeon's final throw, deployed endoscopically through the JNW UrTrac sheath.

Design​

  • Titanium crimping ring preloaded on a single-use handpiece
  • Hemostatic clip-like compression mechanism
  • Integrated cutting blade — trims the suture tails after fastening
  • Single actuation — squeeze the handle to crimp and cut

Use in TUITMR Endoscopic Urethroplasty​

After each suture is placed through the stenotic scar and healthy bladder mucosa using the RD180:

  1. Both suture tails are brought to the desired tension
  2. Ti-Knot applicator is passed through the UrTrac, positioned over the crossed tails
  3. Squeeze-trigger crimps the titanium ring around the tails
  4. Integrated blade cuts the excess suture
  5. Applicator is withdrawn; fastened suture remains in place

Advantages Over Endoscopic Knot-Tying​

  • Speed — no intracorporeal knot-tying required
  • Reliability — consistent compression force; no "loose first-throw" failures
  • Ergonomics — solves the core challenge of endoscopic knot-tying in a narrow urethral corridor
  • Compatible with a single-surgeon workflow — does not require an assistant to maintain suture tension during knot construction

Known Complications​

Retained TK fasteners can calcify over time, creating an intraluminal calculus that may require endoscopic removal. This is analogous to the historical issue of retained hem-o-lok clips migrating into the bladder after robotic prostatectomy. Counseling and surveillance for encrustation are part of TUITMR follow-up.[1]

Other Applications​

The Ti-Knot platform is used across:

  • Laparoscopic gynecologic closure (vaginal cuff, apical suspension)
  • Cardiac surgery (pericardial and sternal closure)
  • Colorectal surgery
  • Any MIS field where endoscopic knot-tying is the rate-limiting step

References​

1. Dash UC, et al. Detailed Surgical Technique for Endoscopic Urethroplasty. Translational Andrology and Urology. 2025. (Describes calcification of retained TK fasteners as a reported complication.)

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