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Hello, good evening. Good afternoon. Good day, wherever you are in the world and welcome to the Black Belt Academy of Surgical Skills. My name is David Re, I'm a retired cardiac surgeon and now a professor in the Medical Education Research and Development Unit of the University of Malaya. We're coming to you from Kuala Lumpur tonight. It is 11 o'clock and our producer, Gabriel is in Lithuania. We are delighted that we are joined by 78 registrations this evening from 24 countries that is thanks to Midwall Georgia Indonesia and for the first time, we've got a new country Jersey, Jordan Mozambique, Spain Sudan. And I'm delighted that the United Kingdom has actually passed 1000. Thank you very much for your support. All this is available on catch up. It is free and we are accredited by the Royal College of Surgeons of Edinburgh and I am the immediate past Director of the Faculty of Surgical Trainers. Tonight, we are going to be talking about Knots and now the history of Knots really is intertwined with human endeavor over time from primitive hands of the ancestors who are pulling branches and bits of animal skin together to modern mathematicians, abstract theories. Knots have really continued to evolve in their complexity and application and they remained a subject of human ingenuity and a symbol of our ability to manipulate physical but also translate that into something profoundly symbolic. It started off as rudimentary with ancient man. Now, a knot really doesn't exist until you fold it over and you get a not, you don't find a knot, find a knot on wood perhaps is derived from knob or knuckle. But in a length, no knot occurs until you physically tie the knot. And that's what our ancient people did. And the oldest knot was found 8000 years ago, 8000 BC as an artifact in Finland, many civilizations have used the knot since in the Inca Empire, the knots were translated into creepers and the creepers were formed as necklaces or decorations. But they were more than that, they were a means of communicating in a written language. There was able to travel over many distances and the message was not lost because it was knotted in ancient Egypt. The Egyptian goddess has a name to the Isis knot, which is a symbol found in jury. And today, of course, we see the Celtic knot also symbolic of a religious time together. And of course marriage is tying of the knot. The Chinese two had a unique relationship with knots and they had a system called an ancient decorative craft of in, in intricate patterns and symbolic again, pieces of art. And of course, the knot was used in the maritime to tying up ships and therefore they needed knots that were secure, but also could be quickly undone. So the bowline the clove hitch, the sheet band were all very important. And of course, the bitter end is the end of the rope. When you ship has lost its mooring, you're holding on for dear end. And that is the bitter end. Of course, the knot was also translated in navigation to knots in a rope and thrown overboard. That was used as a mechanism of measuring the speed of the boat. And hence, even to this day, the knot is part of our maritime language of speed. In the modern nature. Of course, we use not for recreation, particularly rock climbers. The knot, the project knot and the hedge are crucial to climbing safety. And the theory and the breaking strength of knots has resulted in a mathematical specialty. But every time you tie a knot, the intrinsic strength of the material you used is deformed and therefore the strength is diminished. But the knots have also gone into biology and more recently into quantum physics. Heracles was the first to describe the surgical knot in the first century for binding tissues and materials together, we often overlook not time. But it is absolutely fundamental to the practice of surgery because vessels less than a millimeter arteries can be diathermic because you got thick walls and a thick media. Of course, veins cannot be diaphragm because they do not have that thickness and they don't cauterize. But I put it to you everything over a millimeter and any vein should be secured with ligation. Unfortunately, Ligo clips have come into play and I think the art of not tying is perhaps being lost, but clps again, leaving foreign material in the world and that sometimes if not applied properly, the Ligo clips cross and can actually scissor the vessel of the tissue. And the important thing is to understand that the knot, the action of tying a knot decreases the strength, particularly if you got the strength sliding down on itself and the force that is required to tire not, is not significant. In fact, it requires a lightness of touch. So if I press my finger into my forearm, that is enough to secure the knot but not put it down, take it away, but finger on the knot, take it away, finger on the knot, take it away because the finger on the knot is not, is just below it. So you're pulling in opposite directions and therefore tensioning the knot and it does not come undone. And that is the principle of tie knots. Now, you can look up and Google a lot of different videos explaining how to tie a knot. And when I look at them and I've looked at many, there's some elementary factor of tying a knot. That's not explained. You take a length of rope, you cross it over and you got to take one end that end and bring it through this loop. How do you get this short end through this loop? You gotta flick it through and that flicking it through and catching it and I've caught it there between two fingers and I take it away. I have not seen that emphasized at all in any of the not time videos to reiterate cross it over. You gotta get that short hand through this loop. How do you get that short end through the loop is literally flicking it through and carrying it away with two fingers. And we'll demonstrate that as we go along. No, the most common knot that we didn't tie every day is no shoelaces. So if I hold up my shoes here on my right shoe, you see that the lace is across, the shoe is across the shoe on my left shoe, the lace is down the shoe, OK? And bend down the shoe that is a crossed knot. You can see it's crossed. I'm not sure again. And that is an uncrossed or flat knot. The difference is quite clear because if I take a cross knot, you can see the two ends across the knot. And I put, I play around with this and work it pretending I'm work walking every day and voila it comes undone. But if I do a flat walk uncrossed knot, which efe effectively, as you can see, there is a reef knot. And now if I pull it, it does not come undone because these knots self tighten. So if you wondered why your shoelaces come undone, that is because you haven't tied a flat knot. And I'll show the those on the table as we come over and I demonstrate these. So the force to be honest is literally the force of the finger. And there's a publication out in surgery by Emil et al from the Faculty of Medicine in Tel Aviv. And they demonstrated that not only did the expert surgeon tie their knots in less time, they used significantly less force. And that reminds me of my lessons at the Japanese club with a Sensei who keeps on telling me no force, no force. But in their description, the way you position in the line, your body and your hands transmits the force and creates the energy without actually putting any muscle or effort into it. So the message is very simple. It's technique before power and speed. It is lightness of touch and rhythm. And those are the cornerstones of the Black Belt Academy. And it's important we understand these principles when practicing knots. So I am going to take you over and demonstrate a couple of things to you on the principles that I think are important of not tying. Please feel free to interrupt with any questions at any time. Gabrielle who is currently producing will be reading those out and I will be happy to answer your questions as we're going on. Remember this is live and not like most of the videos you see on Google that are formula, somewhat contrived, edited and quite frankly looked too perfect because perfection is something that one never achieves mastery comes through practice and we got to practice until we can't get it wrong. So let me take you over and we can just watch this for a moment. So let's see, just wash my hands and watch carefully and let's see what happens and see if you see anything. Can you see it? You probably can't, you probably, you probably think there's something magic going on. But as we talk about sustainable surgery, I've got a, a little bit of cheese here. I like blue cheese myself. I want to demonstrate something else to you. I'm just tired a lot and this literally is cheese wiring. Sure. The trees and what I'm holding here is a 70 60 monofilament. You probably can't see that under the camera, but that is as fine as human hair. And what I wanted to demonstrate is it doesn't take much force on soft tissue. Literally the 70 to actually cut the cheese. So what are the principles of not time? And I'm now gonna just change the camera again. So bear with me as I try and get a good angle on this and hopefully you can see what is going on. So I have a video available and it describes not time. And first thing to say is that you don't need, just see the orientation. There you go, orientation, right? You don't need a fancy not tying station. We have these plastic things on offer. What I have here is a simple lunch box, a couple of elastic bands and a couple of pencils, Nothing difficult or fancy. So we are going to tie the knot and we always start off with a short hand, there's a short hand and a long hand and I start off with a short hand towards me. OK? And we're going to supernate and let me just get the angle right on the camera. OK? I'm gonna supernate holding a short hand between my thumb and index finger. I'm gonna supernate and hold it out and take the long hand and cross it over the short end. I've got a figure of four. Now the short hand is between the crossover and the bit I'm holding between my finger and thumb. That is the bit that I now have to flick through. Yeah, see that right middle finger is flicking it through and I caught it now between my middle finger and my ring finger and I take it away from me and as I take it away, I put my finger down on the knot, I'm now holding the end between my ring finger and my thumb and I take my extended index finger and again, I hold that short end out, I cross the long end over the short and you see that short end there, I need to flick that through where my finger is. So I flick it through and I flick it through with the back of my fingernail, catch it and I bring it towards me and I now bring my index finger down. And there, I've constructed a flat square reef knot. Once you start going, there's a sort of rhythm to this. But each of the time I'm taking it alternating between fore finger and middle finger throws. And you can have a little game with yourself to see how short or short hand you can get before your ability to tie the knot is curtailed. So that was with the right hand. Can we do this? Likewise, the left hand. And I would encourage you all to learn to tie knots with both hands. You will have a preference in the end. But it's a useful skill. Say the same thing applies short hand between the thumb and index finger. I'm going to supernate my hand. See in my three fingers there, supernate, holding that short end out. I've crossed the long end over the short and I've gotta flick that short bit through that loop with the back of my finger. You see that? And I've caught it and I've taken it away as I take it away, I'm applying are some to my middle finger and now turn out sweep in and I've sort of gone round and I've supernate my hand to hold the short end out is my extended index finger. I cross the long of the short and I've got to get that short end through and bring it back towards me. Note that my hands are moving back and forth, back and forth and that is ensuring that the knot is being tied down flat. So if I show you again what the flat knot looks like and a cross knot, this is simply here in part of these robes. The flat knot you see is a reef knot. There you go. Two ros and itself tightens the cross knot. You can see what and this doesn't sit flat. The cross knot is colloquially called a granny knot. But you can see now the two ends on this direction across the knot that's crossed, that is flat uncrossed knot and it sits flat on the table and that is a cross knot and it doesn't sit flat on the table. So the important thing is is to learn that your hands are moving in different directions all the time. The next step is once you've mastered that ability to move your hands in different directions, to ensure that the knot is flat. One needs to then practice tying the knot onto a surface and you're not lifting it off. So I'm using a coat hanger here, but just for this purpose, but you can use absolutely anything and everything. So now when I'm putting the knot down, you see, because there's a big string and a big coat hanger, my knot, my finger is below the knot. So I'm pulling across the knot, but I, as I'm pulling that, I'm not lifting this coat hanger off the table and having done that, then I can continue tying my knot back the other way. And, um, and what I need to be able to do is to time a knot and bury the knot down each time with a distinct pressure across the knot. But when it's, when it's a thin but its future material, your finger on the knot, the pulp of your finger is giving the feel and you can feel the tension and you'll feel the knot on one part of the pulp of your finger and the rest of your pulp is below the knot. So you're maintaining the knot in position, but helping it bend down. The important thing is once you've tied it to a solid surface, you've got to see does it move? All right. And the idea is to be able to tie to a piece of plastic like this and ensure that it doesn't move. Now, that is very difficult when time knots. And one often thinks that is going to come undone. This is why you put two throws the first direction, two throws, the first direction are half hitches. So now I've got something that slides down as a half edge, two half hitches slides down and now I can further tighten that and lock it as well. So especially at tying your depth, the two half hitches, let's show that to you is you throw a throw one direction and then you throw the flow the same direction. So I've got two half inches now and I am taking that down and that slides down. So those of you who do laparoscopic surgery will actually find that a lot of the pre pair laparoscopic knots are, in fact, half s that enable you to slide down and there you go. So once you've got the principle of hands moving like that, not lifting this off the table, then you can move to thinner material. You don't need suture material. The cotton is uh excellent surrogate for sutures and the cotton comes in a reel and sometimes ligation, sutures do come in res. And in fact, it's the most convenient way to have a suture because you can hold the real in your hand. And it's economical. The thing about not tying though by hand is it is not as economical as instrument tying, but the instrument tying, you could only tie yeah on the skin. So the important thing is to ensure that this is not moving as I'm tying the knot. So that did not bed down because I did not put two half hitches on it and now focus in a bit further. There you go and see if I pull too tight, the cotton it breaks and that's exactly what happens with the suture as well. So there's no force in this and the cotton will also break if you put too much force in it. So it's a lightness of touch and more I feel. Of course, if you want to actually start tying with a monofilament and a monofilament, you can see if I put on the table here. It has got a memory cos it's essentially a plastic and that's the thing about a mono filament. It is a plastic and it's slippery in it slides and that's why you need to put more throws on a monofilament. So how many throws do you put on for a braided suture? I would put in five and for monofilament, I'll put in seven and it is really dependent on the size or the suture that you are using. The thing is to remember with a monofilament because it's plastic. You need to put more throws on. But when you put more throws on and I'll demonstrate that now he end up with a little spike of throws and that little spike you can see that. Yeah, I'll focus in a little bit further. That will spike of throws if not buried in the tissue. And this is why when tie knots with monofilament and all your knots in deeper tissues, you should tie the knot inside, not the outside. So it means you start your stitch from the inside, outside, outside, inside and then tie the knot. It means that you're not as buried. Because if you look at that, that is effectively a little bit of spiky plastic material that I've seen in some thoracotomy wounds protrude out of the skin. You gotta also remember that these knots here are very good for biofilms and bacterial growth as well. And therefore, when I put a monochrome in the skin, I do not put a knot in that any longer. I put a clip on the end, put it through the skin and simply put a liga clip at the end and it'll fall off when it is absorbed that way. I avoid a little nasty inflammatory nidus of not. So how do we practice not having a depth? And again, we have all these wonderful, expensive looking unfriendly eco unfriendly models. And the simple thing to do is take a cup and I fix the cup two plate with a bit of blue tag. And you can see that I've a fixed that at one fanning's deep. Yeah. So we'll try that, try one felling deep and this is where one starts having to think about passing sutures around. And there's a little trick I'll show you as we go to further depth. So there you go around a pencil. This is the red, all part of the more advanced knot tying skills at black pot level. And really we wanting you to be able to secure or not. Ads note that I pause with a knot at the bottom. You listen to this, I think you could hear the suture rasping. But if you look carefully, it's frayed. A bit of cotton is frayed there. And in fact, some people when they're tying it down, you hear that rasping and people are tying so fast. I know the one consultant I work for Mr said, sister, could you give me a syringe, please? And you think why my hands are working so fast and the knots are going down so fast that I'm generating steam. Well, yes, what you're not doing is tying the knot knot correctly and you're allowing the knot to rub on itself and that friction is damaging the knot and therefore you need water on it. So you don't say that. So if I looked at these two knots, one I tied earlier there. All right, I can hold that and it's not moving this one, not moving that one better. So again, your immediate feedback is we gotta practice until we can't get this wrong to be able to secure with a bit of cotton on the pencil. The knot, I'm not pressing hard. I'm just pressing as if I'm dimpling my forearm with my finger. Now, I only put four knots on that because this is a braided suture any more would be a waste of time. Now, I can hold this and there you go. That's a secure knot. All right. Good. Move on next stage. This time it's two fingers deep. Alright. Two fs deep in there. And I'm now tying a depth and the thing is you gotta be able to get your finger in to the bottom. Now, just dangling my suture in at the end in a cup, I can reach down and pick it up. But passing a suture like that into a wound is very difficult to pick up. So there's a magic technique. You use a leg here, your bowstring, there you go across the leg here and I put it across here, your bowstring, your suture across. And now I can pass it down underneath is not wandering around and I can take the lady off and deliver my suture do that in theater when you ask to pass a suture. And I can tell you now, the operator will be significantly impressed with that technique. So, finger on the knot, ok? And the thing is that the, the cotton is very slippy and I'm pausing at the bottom to ensure that it's bedded down. Ok? Now, in cardiac surgery, putting an aortic valve in, you're effectively putting it in sometimes at the bottom of something akin to an empty toilet roll sort of diameter. And I've come across them very rigid and to get your finger down accurately. There you go. I will be convinced. Insecure. Fantastic. Let's go to the ultimate. Now, a pencil is right at the bottom of the cup. OK. So it's almost at finger deep and you can challenge yourself into how far you go again because I'm passing the suture down at depth. I am picking it up with a lady boring to cross. Reminds me of that string instrument and boxing. They do in some skiffle bands. I can take the lady out of the way and, and ready to tie the knot. So it's at depth. And now I've got to be careful one. I'm not sliding the string down and rasping it because that will definitely not be a good idea. It will damage and I need to be able to insure than a bed in not town and it's accuracy and precision. It's not speed and I'm not putting any more than the weight of my forearm here. So that's the thing when I see people practicing knots sitting down, you will not be able to use the weight of your forearm because your wrist is above your elbow. And therefore you will not be able to apply the requisite pressure at depth to ensure that that knot is being bedded down. So let's take that. Oh, it's a little bit loose compared to this one earlier. All right. Oh, dear. Oh, dear. I'm going to have to do that again. And of course, tying a vesel depth it gives and therefore it is going to be a little bit more forgiving about technique but being able to secure a not on a pencil at depth and get it right. That is attention to technique. Oh, there you go. So, now I'm going to do it again and you do it again until you get it right. Oh, I'm tying the knot but it's not as tight as I'd like it to be. But I'd keep on practicing. And the thing is by keeping on practicing. Yeah, keeping on practicing. I'm actually also working out what is the strength of this material and that I can put on this cotton before it actually breaks. So I'm learning with a cotton to feel the force that I'm putting on it. And this is demonstrating to me as well and to you that when you actually tire or not, so I'm gonna put two throws the same direction and I'll show that to you in a moment and take it down flat and this time pause because there's a lift up and relax that that's not gonna come done. So there you go. Uh See it's still not, it won't show you this or one of those manufactured videos in Irish time Knots. The thing is, is that this step when you lift up to try and actually secured on that surface, lifting it up is in fact loosening the knot. See that as soon as I try turkey bear the knot down. I'm lifting the string up and I'm starting to undo it. Yes. You don't hear the sound again. I've just heard for the purposes of teaching. Listen. Did you hear that rasping, thumbs up in the chat room. If you did? Let's see this time. Yes, that is a secure. Not. So, the whole thing about these exercises, you repeat them until you can't get it wrong. So, if I was actually continuing to practice, I would actually then focus, um, repeating the exercise again and again, until I've got, let's say 10 sutures on my pencil and they're not coming undone. So there's an art to not time that I hope I've described it doesn't require much in the way of force. What it does require is attention to technique, minimal pressure because more than that no cotton will break, understanding the movement of your hands and then you two can progress to tying seven ohs or six ohs. Now, the thing is with the 70 and 60, you're gonna be wearing surgical gloves, aren't you? So your fidelity is going to be somewhat attenuated if you don't wear the proper gloves and if you wear gloves that are too tight, your fingers are gonna go numb and you'll not feel a knot. Likewise, if they baggy and you've got lots of excess material, again, you will not feel the knot. So having gloves that literally coat your fingers. But don't squeeze them with no baggy bits. That is the ideal. So the last bit of time, not that we need to understand is drains no bit of hose pipe will do. Or garden hose. I actually have a drain here in my box back in the UK that I haven't been able to return to. I've got a bit of garden hose. And what I do in that circumstance is t or not. You t one through, through round and you try a second throw. So it's two, throws the same direction and the two throws the same direction, bind into the plastic. So this is a, a bit of string. We're gonna put two throws, one, two, the same direction and I'm gonna take that down. My 70, is getting in my way here. I just remove it from the table, take it down and now I'm gonna tie this down and as I tie this double knot down, you can see that it's very good at squeezing and biting into the plastic and this is the perfect knot to use for drain. And then I continue to secure this knot with a series of flat knots. Ok? And what I need to be able to do with my drain is it has to bite into the drain and distort it such that there's no way even with force, I cannot move that drain. One of the biggest problems particularly with chest drains and we'll cover that in another session is failure to secure your drain properly. Remember, drains are very useful in surgery. When there's any potential contamination or a fluid space or a potential fluid fluid leak bile or lymph, you need a drain and you need to be able to secure it with a properly secured knot and there you go. That's it. So we've covered the basics of not tying this evening. I note that my fellowsi Chris caddy has joined us and he's a microsurgeon and he does a lot of not tying. We together witnessed a lecture by Suja who is our new sense and a corneal surgeon at the University of Malaya. And she specializes in corneal transplant and corneal surgery. And they use, I think a 10 0 suture and they have a special instrument for inverting the knot. So it tucks it under the edge, but their tension has to be absolutely precise and the knots have and the placement have to be perfectly radial. But even that 10 0 suture that they're using for corneal surgery. If it's not tied properly, then it'll cut through. Now, what is interesting in most cases, we would say that you tie the knot and leave it slightly on the loose side because inflammation in the process of healing will mean that the edema is maximal at 3 to 4 days. The inverse is true with tying knots with eye surgery because the edema on the cornea is almost immediate. So therefore, they need to slightly over tighten them because if they didn't do that, when the edema settled, the knots would be too loose. So the field and the balance they have to achieve. And the tension of the suture is a lot more critical than I've seen in many other specialties. And it was lovely to see the way SAA described and explained the necessary tension in the suture and the importance of correct not time. And probably Mr Caddy, are you there? He was there is there but any questions for me? He is with you but his, his video is not working. I had a power outage in the middle of your transmission. Oh You were in the, in the middle of Storm Boris. Actually, I'm back online but I had I was on both my iphone and my that's called engineer for you, sir. Well done. So anything to add in the discussion about knots from your perspective as a plastic surgeon or microsurgeon using fine sutures that we often use instruments to do our tying. And as you were pointing out with the ophthalmologist, it's in the feel of the suture. So just as if you're too strong, you break the suture. Uh but you have to watch how the the tissues are behaving as you bend down the knot. And then what Sujay was showing is how they rotate the knot back into the, the eye. So it's not left on the outside. Yeah. And, and that was quite remarkable, wasn't it? And I hadn't quite appreciate it. Didn't they have a special instrument for doing that as well? And I think that's what's nice and what we lose sometimes in our surgical training is witnessing or appreciating what other specialties are doing often. There's not anything new and sorry. It's just because the way we teach and the way we learn has become so blinkered and so restricted in our thinking, right? OK. Any questions from anybody online? Not as much as a question, but we have a request if you could demonstrate a two handed surgeon, oh, a 200 surgeons. So II see these people do this sort of switching through things and to I gotta be confessed. I don't know how it's done to me that just seems a bit sort of the, the people who do it do it wonderfully well. But I have not learned that. So I'd love to be able to demonstrate that to you. My 200 surgeons knot will probably be akin to tying my shoelaces, which I do every day, but we now know how to tie them properly. I, the caddy actually asked me, what have I learned from the struggles? Well, the thing is that each time you struggle and it is difficult on these models, you have to think to yourself which elements are making this problematic. And these models are deliberate to test the various elements of not tying there's no point having a model that's easy where you can tie it and say there it's done. You need a model that is going to test all the elements of the time. And it was a process of learning to feel the tension that I was putting on the suture. And also when I lifted the strings up, recognizing as I lifted them up, I was actually undoing the knot. And this is particularly true if you at depth. And that's why having two half hitches or this a knot of two throws sometimes enables that because undoing because if I pull one end up, it locks on itself. And that is the advantage of that. So I was experimenting with two different things. There, two half etches to parachute it down. The cotton doesn't, is not coated. Many of our braided sutures are coated. And in fact, in the very beginning when sutures were made, the sister at the side, assisting before the suture was used would coat them in a silicon based oil. So they glide. The thing is about the cotton is not coated. So again, it really does remind you to use your suture material correctly. If you're hearing particularly in the cup, the cup is amplifying the sound of the cotton rasping on the strings, then you know, you, you're not putting it down and that rasping is actually frame, you know, I could see it. I don't know if you could see it on the camera freeing the cotton. That's exactly what a knot is doing. And the science of knot, the best you can do to maintain. If you think if a string is 100% the best knots only maintain about 85% of the strength of the original material because of the nature of the knotting distorting and compressing as well. And that's why it all comes down to the feel and you have to be able to use the palps of your fingers. Any other questions, please? Well, I'd like to thank you very much for your attendance if this is your first time. Thank you, please. I do have one question. Pass the word. Sorry to interrupt. Thank you, Gabriel. Yes. So Sander is asking for not time using monofilaments. The first frow tends to lose while trying to do the subsequent fro how can we prevent well with a monofilament? Then I use two half hitches because then it slides down on itself very well. Or if it's on a more superficial one, I actually use the A knot which is two, throws the same direction and that ensures that the knot actually stays down. Um The thing is it's practice, practice, practice and you practice until you can't get it wrong. Remember, not failures result in significant problems. So I think, and I enjoy these models because the learning is actually in the struggle to get it right if it was easy and you could do it just like that you wouldn't necessarily go through the process of learning and recognizing the different elements. And I hope that we've explained to you the different elements of an importance of not tying. Please do it standing up. Don't try and practice knots set down because you will not get the weight of your forearm that gives you that dumpling pressure. Thank you for joining us to all of you around the world. It is much appreciated. Do tell your colleagues this is free. We welcome you your participation. And I must say if Sr Soleiman is listening, he was one of the winners for our global competition and he won because he demonstrated knot time on a plastic glove filled with water. And what he tried to do is tie the knots off. And what we haven't done this evening is use a balloon. I've tried to tie this part of the balloon before it's fine if you can actually twist it. But the shorter part of the balloon and tying it is actually a good test of skill and you could cut the end off and this end on a high perhaps or low. Can we actually tie the knot to the end of this balloon? Ensure that it's not gonna come and done. Oh, deflated. And that's because in trying to tie quickly, I broke the cotton and only had two throws on. So less haste, more, more speed, less haste. It doesn't pay to try and do things quickly. Thank you. And we'll see you next week. Wish you well.