Core Surgical Skills ...

Tying knots deep within a body cavity or recess can be challenging. In order to avoid tearing tissue or avulsing a blood vessel under these circumstances, you must practice forming knots without creating dangerous tension along the tissue plane. This is best accomplished using the deep two-handed tie technique.

With this technique, it is very useful to use the gathering and sliding maneuvers to fine-tune the amount of suture. Pay particular attention to these gathering and sliding movements as you watch the videos and practice these throws.