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This instrument facilitates the tying of ligatures at points which the fingers cannot easily reach.
An assistant holds the handle of the forceps in the usual way for removal. The operator takes a ligature, ties a simple overhand knot around the handle of the forceps and brings the ends of the ligature down astride the handle, holding them between the first three fingers of the left hand. Then the tier is hooked on the end of the ligature nearest the right hand, from the under side, and given two turns to the right, which will put the ligature within the spiral or head of the instrument. The spiral is now pushed up to the knot, and the end of the ligature is held against the handle of the tier by the thumb or first finger, the other end being held by the left hand.
The knot is now pushed down
Boettcher HR. A LIGATURE KNOT TIER. JAMA. 1917;LXVIII(19):1403. doi:10.1001/jama.1917.04270050105008