Suture Ligating[edit | edit source]
Step-by-step Procedure to Suture Ligating[edit | edit source]
1
Attach your glove longitudinally in the plastic container using four binder clips
- Use one binder clip to attach the wrist of the glove to the plastic container
- Use an additional binder clip to attach the fourth finger to the opposite end of the plastic container
- Use another binder clip to attach the fifth finger to the side end of the plastic container
- Use the last binder clip to attach the second finger to the opposite end of the plastic container
2
Using a haemostat, clamp the base of the second finger
- Open the jaws of your haemostat with your dominant hand
- From the side of the second finger that is closest to you, advance the jaws of the haemostat such that they are perpendicular to the finger
- Advance the haemostat until the entire width of the finger is enclosed in the jaws
- Clamp closed the haemostat
- Ensure that you have clamped the haemostat such that you hear only 1 click
- There is rarely a time when operating on human tissue that you will need to require more than one click on any surgical instrument
3
Throw a forehand stitch through the base of the fourth finger, proximal to the haemostat
- Load your needle driver
- Holding the needle driver in your dominant hand, pronate your hand
- Place the needle below the glove
- Line the needle tip directly below the mid-point of the haemostat that is clamped across the fourth finger
- Supinate your hand to push the needle through the glove
- Grasp the needle with forceps
- Release the needle driver from the needle
- Reload the needle on the superior surface of the glove by pronating your hand
- Supinate your hand to pull the needle out of the glove
- Pull the remaining suture until only a 2 cm tail is left on the inferior side of the glove
4
Instrument tie a surgical knot
- Wrap the suture from the superior surface around the needle driver twice
- Open the jaws of the needle driver and grasp the tail of the suture
- Pull your knot tight
- This knot should be placed on the superior surface of the glove
5
Wrap the running end of the suture around the finger proximal to the haemostat
- In the operating theatre, you will need to guide your assistant to help you pass the suture
6
Now, instrument tie
- The first should be a surgeon’s knot
- Remove the haemostat that you placed across the finger and continue to tighten your knot
- In the operating theatre, you will have your assistant slowly remove the haemostat
- Now tie the remaining number of knots appropriate for the suture material, ensuring they are square knots
7
Cut the suture with appropriate length tails
- Ensure the tails are not so short that the knot unravels