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Volume 647 Issue 8091, 27 November 2025
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Volume 647 Issue 8091, 27 November 2025

Knot exactly

Tying knots in surgical sutures requires precise amounts of force — too little force and the sutured wound will gape and leak, too much and the wound will bloat and blood flow becomes restricted. Robots can help, but their complex sensing systems are hampered in operations with limited space, such as minimally invasive surgeries. In this week’s issue, Tiefeng Li and colleagues analyse the force mechanics of the simple slipknot and reveal that it can be used to transmit force mechanically to close wounds consistently without the need for electronics. The researchers found that topologically designed slipknots can deliver force with 95.4% consistency. They used this to design a system they call a ‘sliputure’ in which a slipknot is added to the surgical thread alongside the normal surgical knot. The surgeon ties the surgical knot on the wound as usual, but then pulls the slipknot until it opens, which transmits the appropriate amount of mechanical force to close the surgical knot to the correct pressure. In tests, the team found that the sliputure approach improved the knot precision of inexperienced surgeons by 121%, and also aided blood supply and tissue healing after surgery.

Cover image: Chaoyang Zhao/Kaihang Zhang/Tiefeng Li.

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