Introduction
Basic principles for tying instrumental knots with the aid of a needle holder:
- Multiple sutures are tied with the same thread.
- Each stitch requires a surgical knot and two single knots.
- Two threads of considerably different lengths are tied together.
Procedure
Instrumental Knotting
Instrumental Knotting: Atraumatic Thread
Tie a surgical knot as follows:
- Hold the needle between the left thumb and forefinger [Figure 60].
- Hold the needle holder in the right hand with the jaws pointing left.
Figure 60
Figure 61
- Place the needle guide against the thread [Figure 61].
- With the left hand, pass the long thread around the jaws of the needle holder twice, moving the thread away from you [Figure 62].
Figure 62
- Open the jaws of the needle holder and use them to grip the end of the short thread [Figure 63].
Figure 63
- Let the double loop around the jaw of the needle holder, slip off and pull the thread tight [Figures 64, 65].
- The needle holder moves toward you.
Figure 64
Figure 65
- Open the needle holder to release the short thread.
Tie a single knot on top of the previous knot:
- Place the needle holder under the thread [Figure 66].
Figure 66
- Loop the long thread around the needle holder once [Figure 67].
Figure 67
- Open the jaw of the needle holder and use it to grip the end of the short thread [Figure 68].
Figure 68
- Let the single loop slide off the jaws of the needle holder and pull the thread tight [Figures 69, 70].
- The needle holder moves away from you.
Figure 69
Figure 70
- Open the needle holder to release the short thread.
Tie a single knot on the top of the previous knot in the opposite direction:
- Place the needle holder against the thread [Figure 71].
Figure 71
- Loop the long thread over the needle holder once, moving the thread away from you [Figure 72].
- Open the jaw of the needle holder and use it to grip the end of the short thread [Figure 72].
Figure 72
- Let the single loop around the jaw of the needle holder slide off and pull the thread tight [Figures 73, 74].
- The needle holder moves toward you.
- Open the needle holder to release the short thread.
Figure 73
Figure 74
- Cut both threads simultaneously 1 cm from the knot.