the view is limited by what can be seen on a tv screen further bearing in mind that the movements of the instruments are effected outside of the body by the grasping portion of the instrument tying of a knot in a suture under such conditions can be a time consuming process with the laparoscopic instrument of the present invention the forming of a loop and a knot in a suture is greatly facilitated because as previously indicated the loop can be passed over the backside 54a of the inner jaw 54 to support the loop as the instrument is manipulated and the other jaw 14 is used to grasp the free end of the suture and pass it through the loop to form the knot fig5 to 8 are schematic representations of one example of using the laparoscopic instrument for tying a knot in a suture in fig5 the intermediate jaw 54 is opened and the instrument manipulated to drape a suture 70 over the backside of the open intermediate jaw 54 subsequently the instrument is turned and manipulated to twist or wrap the suture 70 about the barrel 10 as shown in fig6 and then the end jaws 44 grasps the free end 70a of the suture as shown in fig7 whereupon the intermediate jaw 54 can be closed so that the grasped end 70a of the suture can be pulled through the loop 70b to make a knot as shown in fig8 although the jaws in fig1 and 2 are shown as having serrations the mating faces of the jaws may also have smooth surfaces although in the drawings the pivotal jaws 44 54 are shown in the open position as disposed at an acute angle relative to the longitudinal axis of the barrel 10 either.