Preparations
Instructional Video Perspective
Throughout this module, we will utilize a consistent standard orientation to demonstrate the knot-tying techniques. The knot-tying board that you will see in the video demonstrations represents a simulated horizontal incision, shown from the perspective of the surgeon.
To simulate pedicle ligations, a vertical plane has been shown.
You will notice that all demonstrations in this module show knot tying with the surgeon moving his or her arms toward and away from the body, parallel to the orientation of the suture loop. This orientation prevents the student from losing view of the formed knot during the hand and arm maneuvers. Other knot-tying technique resources sometimes show the surgeon's hand and arm movements perpendicular to the orientation of the suture loop. However, the hand or arm crossing temporarily blocks the surgeon's visualization of the knot construction and tissue plane of interest. In addition, this clumsy hand motion can interfere with the surgeon's ability to apply equal tension on suture ends, inviting an unwanted conversion from a square to a slipknot. For these reasons, we have chosen to present the instructional videos in the parallel orientation.
Practice Supplies and Set-up
- Suture board
- 4-inch (10 cm) plastic cup and hook
- 24-inch (60 cm) strand of 1/8-inch (3 mm) flexible nylon rope
- 2-0 or 3-0 suture material, fishing line, or sewing thread
- Surgical gloves
- Needle holders
- Suture scissors
Lesson 3 contains a series of instructional videos demonstrating knot-tying techniques. We recommend that you practice the knot-tying techniques as you follow along with these videos. For clarity, in this module, we have utilized a nylon rope instead of suture material to demonstrate the knot-tying techniques. This thick rope will help you visualize the steps required to form each knot correctly. A knot has been created at one end of the rope to designate the fixed strand representing the attached needle.
To practice tying knots, we recommend that you use a 1/8-inch (3 mm) braided nylon rope. The use of a thick rope readily shows how you are configuring your knots, and it is easier to handle than actual suture material when you are first learning these techniques. Knot one end of the rope to designate the fixed end of the suture strand.
Once you have become proficient at knot tying using a rope, switch to thinner multifilament sewing tread or limp nylon fishing line to mimic suture. Alternatively, you can use 2-0 or 3-0 suture material. At this stage of your practice, you will also need needle holders and suture scissors to practice making knots. In this intermediate stage, it is still a good idea to practice the technique ungloved.
Finally, master your knot tying technique while wearing gloves, using actual suture material as if you are tying in a surgical procedure. When practicing manual knot ties, it is a good idea to lightly moisten your gloves with water or saline first to mimic the fluids encountered in surgery. It is generally easier to form hand ties when suture and surgery gloves are moistened.