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OUTLINE

SURGERY DECURY I. TYPES OF SURGICAL SUTURES


II. ONE-HAND TECHNIQUE
HAND TYING A. Overhand
Dr. Abraham Cinio B. Underhand
III. TWO-HAND TECHNIQUE
A. Overhand
B. Underhand
IV. INSTRUMENT TIE
V. LAPAROSCOPIC ACCESS
VI. ADDITIONAL NOTES FROM OLD TRANS

I. TYPES OF SURGICAL SUTURES

II. ONE-HAND TECHNIQUE

VIDEO: https://youtu.be/3XiDw69ON1U

Transcribers: SURGERY TEAM Page 1 of 7


A. OVERHAND (One-Hand Technique)

Get your suture around a hook or ring START WITH YOUR SUTURE RULE: IF THE THROWING HAND Make a loop with the index finger.
to fix it in place. Decide on which CROSSED. HAS THE SUTURE ON TOP, START Note that the suture now crosses at
hand will perform the one hand tie. This will ensure a flat and square WITH THE INDEX FINGER. your finger and not by the hook.
This is the "throwing" hand. (It knot. The "throwing hand" (left Hold the string between your
throws the free end through the hand) has the part of the suture thumb and middle finger with the
loop). that's on "top". Note that the index finger extended and below
suture is crossed at the hook. the "top" suture.

Pull back your index finger like you're If you pulled back the index finger far Continue pushing with the index Grab the loop between your index
squeezing a trigger. Ensure that your enough, you should be able to place finger as you "throw" (guide) it and middle finger and pull it
thumb and middle finger do not move the suture behind the nail of your through the loop. Get ready to through the loop.
to keep the suture on tension. index finger. This will guide the free extend the middle finger of your
end of the suture through the loop. throwing hand to catch the free end
of the suture.

Hold the free end of the suture now Continue pushing the knot
with your middle finger and thumb so approximately 1 cm away from the
you can push the knot with your knot until it's secure. Make sure
index finger. The hand that pushes counter tension is applied 180
down the knot depends on which degrees from the index finger to
hand has more space to do so. have a zero net tension on the tissue.

Transcribers: SURGERY TEAM Page 2 of 7


B. UNDERHAND (One-Hand Technique)

Now let's tie with your "throwing" Grab the free end of the suture with "Karate chop" the suture with the Form a loop around your ring and middle
hand holding the suture on the your index finger and thumb. lateral aspect of your ring and fingers.
"bottom". Note that the suture is middle finger. Note the suture is now crossed at your
crossed by the hook. fingers and not by the hook.
RULE: IF THE THROWING HAND
HAS THE SUTURE ON BOTTOM,
START WITH THE THUMB.

Pull back the middle finger only. If your middle finger pulls back far Let go of the suture between your Turn your hand to face the palm down.
Keep tension with your thumb and enough, the suture will be able to thumb and index finger, and grab it This will turn your middle and ring
index finger on the free end of the rest on the nail of the middle finger. between your middle and ring fingers so it can pass through the loop
suture. This finger will then "throw" (guide) finger. more easily.
it through the loop.

Pass the free end of the suture Grab the suture and maintain Push the knot down with your Again the hand that pushes the knot
through the loop. Get ready to grab tension with your thumb and middle index finger approximately 1 cm down does not have to be the
it with your thumb and middle finger. from the knot. "throwing" hand, but instead the hand
finger. that has more free space (within your
surgical field) to do so.

Continue alternating with the suture on "top" and the suture on "bottom" techniques.

Transcribers: SURGERY TEAM Page 3 of 7


III. TWO-HAND TECHNIQUE

VIDEO: https://youtu.be/Xv5ZIRRQL90

Transcribers: SURGERY TEAM Page 4 of 7


A. OVERHAND (Two-Hand Technique)

Apply your practice "suture" to a hook START WITH YOUR SUTURE RULE: IF THE THROWING HAND HAS Face your palm down. Make sure the
or ring. Decide on which hand will CROSSED. This will ensure a flat and THE SUTURE ON TOP, START WITH suture is on the lateral aspect of your
perform the two hand tie. This is the square knot. The "throwing" hand THE INDEX FINGER. index finger. Note the suture is now
"throwing" hand. (left hand) is holding the part of the Grab the suture in your hand with just crossed at your index finger and not
(Throwing hand: It holds the fixed suture on "top". Note that the suture the index finger extended under the by the hook.
end and throws the free end through is crossed at the hook. suture.
the loop).

Pinch your fingertips. This will act as Now pass the thumb through the loop Pass the free end of your suture Pass the free end back through the
a "carriage" to "throw" the free suture keeping the TIPS of your fingers between your throwing hand's thumb loop. As you can see, the
end through the loop. together. This ensures that you keep and index finger. thumb/index finger acts as a carriage
tension on both parts of the suture to to guide the free end of the suture
prevent knot slippage or "air knots" through the loop.
with each throw.

Pull the remaining free suture through the loop. Grab the free end with your non-throwing hand. Cinch the knot down while maintaining tension in
Note that the knot is "flat". If it doesn't lie flat, you While applying equal and opposite tension, push opposite directions, 180 degrees from each other,
probably started this tie with the index finger while the knot down using your index finger on the suture to minimize tension on the tissue.
holding the string on "bottom". approx. 1 cm from the knot.

Transcribers: SURGERY TEAM Page 5 of 7


B. UNDERHAND (Two-Hand Technique)

Let's tie with your "throwing" hand Externally rotate your thumb (clockwise Pinch the TIPS of your thumb and index Retract your thumb and pass your
holding the suture on the "bottom". with the left hand) around the suture so finger. index finger instead. Note that the
Note that the suture is crossed by the it rests on the lateral part of your thumb. tension of both parts of the suture now
hook. RULE: IF THE THROWING HAND Lay the free end of the suture across. rest on the index finger. This constant
HAS THE SUTURE ON BOTTOM, START Note: it's crossed at the thumb now. tension is one advantage of tying with
WITH THE THUMB. two hands.

Pass the free end of the suture to the Now pass the free end of the suture Grab the free end of the suture with
index finger and thumb of the throwing back through the loop. your non-throwing hand. Note that the
hand. knot is "flat". If it doesn't lie flat, your
probably started this tie with your
thumb while holding the string on
"top".

While applying equal and opposite Cinch the knot down while maintaining
tension, push the knot down using your tension in opposite directions, 180
index finger on the suture approx. 1 cm degrees from each other, to minimize
from the knot. tension on the tissue.

Transcribers: SURGERY TEAM Page 6 of 7


IV. INSTRUMENT TIE

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