Sutures and Suture handling

Tying Ligatures and Sutures

• Square Knot
• Surgeon's Knot
• Deep Tie
• Ligation Around a Hemostatic Clamp
• Instrument Tie

VCS 511 General Surgery Laboratory

VCS 511 General Surgery
Laboratory

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each video

Demonstration Videos:

 

Hand Ties

Two-handed
tie (right-handed surgeon)

One-handed
tie (right-handed surgeon)

Two-handed
tie (left-handed surgeon)

One-handed
tie (left-handed surgeon)

 

All of the following
demonstrations show a right-handed surgeon

 

Using the scalpel

Loading
the scalpel blade

Pencil grip

Finger-tip
grip

Incising using
the finger-tip grip

 

Loading the needle holder for a right-handed
surgeon

Correct
grasp of needle

Incorrect
grasp of needle

 

Suture Patterns and Instrument Ties

Simple interrupted
suture with 2 square knots

Simple interrupted
suture with a slip knot

Surgeon’s
throw

Simple continuous
suture beginning with a surgeon’s knot

Cruciate suture

Horizontal
mattress suture

Vertical mattress
suture

Ford interlocking
suture beginning with a surgeon’s knot

Simple
interrupted sutures with a buried knots

Simple
continuous suture with buried knots

Note that when finishing
the suture, the loop and the free end of suture that you will tie together
must be on the same side of the last suture crossing the wound in order for
the knot to bury.

Continuous
Lembert suture

Continuous
Cushing suture

An alternate method of
finishing the Cushing suture is to finish it as a Lembert (as it was started).
For the last suture, reverse the needle and place a Lembert suture across
the incision. You then tie the loop that is on one side of the incision to
the free end of the suture that is on the other end of the incision.

Continuous
Connell suture

An alternate method of
finishing the Connell suture is to finish it as a Lembert (as it was started).
For the last suture, reverse the needle and place a Lembert suture across
the incision. You then tie the loop that is on one side of the incision to
the free end of the suture that is on the other end of the incision.

its a pdf not a video but is good enough for this site

PDF]

BASIC KNOTS

File Format: PDF/Adobe Acrobat - View as HTML surgical circumstance and the experience of the surgeon. An important part of good suturing technique is correct method in knot tying. A seesaw ... www.ruralareavet.org/PDF/Surgery-Knot_Tying.pdf

Basic Suturing Teaching Modules include:

BASIC SUTURING

 - Created by: B. McCraw,
J. Caudle, J. Chenkin & K. Sampsel,
Technical Skills Program,
EM Technical Skills Lab, Department of Emergency Medicine, School of Medicine, Faculty of Health Sciences,
Queen's University, Kingston, Ontario, Canada


Multimedia Clinical Skills & Clinical Procedures: Basic Suturing
Teaching Modules (Text, Images, Videos/Movies & Audio/Sound).
 Modules include:

"...Introduction; Equipment Tray; Suturing Steps; Knot Tying; etc..."

Video Instruction of Procedures in the Emergency Room (VIPER): Wound Closure

iROCKET Learning Module: Project VIPER: Wound Closure

Filmed and produced by

• Michelle Lin, MD FACEP FAAEM
• Justin Wilkinson, BA

For any questions or comments, please contact Dr. Michelle Lin at mlin@sfghed.ucsf.edu.

All
of the following links are to RealVideo clips; you must have RealPlayer
installed to view them. (Click the link to download the free version of
RealPlayer on the download page.)

1. Equipment (1:54)
2. Anesthesia (3:09)
3. Irrigation (1:11)
4. Starting the Procedure (2:30)
5. Simple Interrupted Suture (3:45)
6. Horizontal Mattress (3:11)
7. Vertical Mattress (1:10)
8. Corner Suture (1:30)
9. Buried Suture (1:51)
10. Dermabond (1:56)
11. Steristrip (0:39)
12. Staples (0:47)

Knot Tying and Suturing

Two Hand Tie 	 
One Hand Tie	 
Instrument Tie	 
Simple interrupted stitch	 
Vertical mattress stitch	 

Operation Anubis:

First NOTES cholecystectomy -

It doesnt cost to log on to the website- fill the form , click on your email and voila..



J Marescaux (France), B Dallemagne (France), S Perretta (France), D Mutter (France), A Wattiez (France), D Coumaros (France)

2007 April







This video shows the first totally NOTES cholecystectomy via a transvaginal approach in a 30-year-old woman with symptomatic cholelithiasis. The operation was performed by a multidisciplinary team, which included a gynecologist who performed and closed the colpotomy. The peritoneal cavity was entered through an incision in the posterior vaginal cul-de-sac. The transvaginal access to the peritoneal cavity and the introduction of the double channel gastroscope (KARL STORZ-Endoskope®, Germany) were performed under laparoscopic control by a 2 mm needle-scope.



The placement of this 2 mm needle-port was mandatory to insufflate CO2 and to monitor the pneumoperitoneum and it turned out helpful for further retraction of the gallbladder. Complete identification of the structures of Calot’s triangle was achieved. The dissection began in close proximity of the gallbladder at the junction between the infundibulum and the cystic duct. The peritoneum covering the cystic duct was incised anteriorly and posteriorly and gently brushed away with blunt dissection. Once sufficiently skeletonized, the cystic duct and artery were clipped twice on patient side and once on gallbladder side and divided with endoscopic scissors. Using an endoscopic grasper and a Storz unipolar round-tip electrode, the gallbladder was dissected away from the intrahepatic fossa and placed in a specimen retrieval bag prior to removal through the vagina. The operative site was checked to ensure hemostasis and rule out any inadvertent injury to the adjacent organs. The colpotomy was closed with interrupted 2/0 Vicryl stitches.



 All the procedure was carried out using a standard double channel video flexible gastroscope and standard endoscopic instruments. All the principles of laparoscopic cholecystectomy were strictly respected. At no stage of the procedure there was a need of laparoscopic assistance. No complications occurred during the procedure. The advantages of laparoscopy, namely minimal postoperative pain and abdominal scarring appeared to be enhanced by this approach. The patient had no postoperative pain, “no scars” and was discharged on the second postoperative day.

English - 04'08''







Also see http://www.websurg.com/notes/index.php