OUTLINE

SURGERY DECURY I. TYPES OF SURGICAL SUTURES

II. ONE-HAND TECHNIQUE
HAND TYING A. Overhand
Dr. Abraham Cinio B. Underhand
III. TWO-HAND TECHNIQUE
A. Overhand
B. Underhand
IV. INSTRUMENT TIE
V. LAPAROSCOPIC ACCESS
VI. ADDITIONAL NOTES FROM OLD TRANS

I. TYPES OF SURGICAL SUTURES

II. ONE-HAND TECHNIQUE

VIDEO: https://youtu.be/3XiDw69ON1U

Transcribers: SURGERY TEAM Page 1 of 7

A. OVERHAND (One-Hand Technique)
Get your suture around a hook or ring
to fix it in place. Decide on which
hand will perform the one hand tie.
This is the "throwing" hand. (It
throws the free end through the
loop).
Pull back your index finger like you're
squeezing a trigger. Ensure that your
thumb and middle finger do not move
to keep the suture on tension.
Hold the free end of the suture now
with your middle finger and thumb so
you can push the knot with your
index finger. The hand that pushes
down the knot depends on which
hand has more space to do so.
Transcribers: SURGERY TEAM
START WITH YOUR SUTURE
CROSSED.
This will ensure a flat and square
knot. The "throwing hand" (left
hand) has the part of the suture
that's on "top". Note that the
suture is crossed at the hook.
If you pulled back the index finger far
enough, you should be able to place
the suture behind the nail of your
index finger. This will guide the free
end of the suture through the loop.
Continue pushing the knot
approximately 1 cm away from the
knot until it's secure. Make sure
counter tension is applied 180
degrees from the index finger to
have a zero net tension on the tissue.
RULE: IF THE THROWING HAND Make a loop with the index finger.
HAS THE SUTURE ON TOP, START Note that the suture now crosses at
WITH THE INDEX FINGER. your finger and not by the hook.
Hold the string between your
thumb and middle finger with the
index finger extended and below
the "top" suture.
Continue pushing with the index Grab the loop between your index
finger as you "throw" (guide) it and middle finger and pull it
through the loop. Get ready to through the loop.
extend the middle finger of your
throwing hand to catch the free end
of the suture.
Page 2 of 7
B. UNDERHAND (One-Hand Technique)
Now let's tie with your "throwing"
hand holding the suture on the
"bottom". Note that the suture is
crossed by the hook.
RULE: IF THE THROWING HAND
HAS THE SUTURE ON BOTTOM,
START WITH THE THUMB.
Pull back the middle finger only.
Keep tension with your thumb and
index finger on the free end of the
suture.
Pass the free end of the suture
through the loop. Get ready to grab
it with your thumb and middle
finger.
Continue alternating with the suture on "top" and the suture on "bottom" techniques.
Transcribers: SURGERY TEAM
Grab the free end of the suture with
your index finger and thumb.
If your middle finger pulls back far
enough, the suture will be able to
rest on the nail of the middle finger.
This finger will then "throw" (guide)
it through the loop.
Grab the suture and maintain
tension with your thumb and middle
finger.
"Karate chop" the suture with the
lateral aspect of your ring and
middle finger.
Let go of the suture between your
thumb and index finger, and grab it
between your middle and ring
finger.
Push the knot down with your
index finger approximately 1 cm
from the knot.
Form a loop around your ring and middle
fingers.
Note the suture is now crossed at your
fingers and not by the hook.
Turn your hand to face the palm down.
This will turn your middle and ring
fingers so it can pass through the loop
more easily.
Again the hand that pushes the knot
down does not have to be the
"throwing" hand, but instead the hand
that has more free space (within your
surgical field) to do so.
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III. TWO-HAND TECHNIQUE

VIDEO: https://youtu.be/Xv5ZIRRQL90

Transcribers: SURGERY TEAM Page 4 of 7

A. OVERHAND (Two-Hand Technique)

Apply your practice "suture" to a hook
or ring. Decide on which hand will
perform the two hand tie. This is the
"throwing" hand.
(Throwing hand: It holds the fixed
end and throws the free end through
the loop).
START WITH YOUR SUTURE
CROSSED. This will ensure a flat and
square knot. The "throwing" hand
(left hand) is holding the part of the
suture on "top". Note that the suture
is crossed at the hook.
RULE: IF THE THROWING HAND HAS
THE SUTURE ON TOP, START WITH
THE INDEX FINGER.
Grab the suture in your hand with just
the index finger extended under the
suture.
Face your palm down. Make sure the
suture is on the lateral aspect of your
index finger. Note the suture is now
crossed at your index finger and not
by the hook.

Pinch your fingertips. This will act as
a "carriage" to "throw" the free suture
end through the loop.
Now pass the thumb through the loop
keeping the TIPS of your fingers
together. This ensures that you keep
tension on both parts of the suture to
prevent knot slippage or "air knots"
with each throw.
Pass the free end of your suture
between your throwing hand's thumb
and index finger.
Pass the free end back through the
loop. As you can see, the
thumb/index finger acts as a carriage
to guide the free end of the suture
through the loop.

Pull the remaining free suture through the loop. Grab the free end with your non-throwing hand. Cinch the knot down while maintaining tension in
Note that the knot is "flat". If it doesn't lie flat, you While applying equal and opposite tension, push opposite directions, 180 degrees from each other,
probably started this tie with the index finger while the knot down using your index finger on the suture to minimize tension on the tissue.
holding the string on "bottom". approx. 1 cm from the knot.

Transcribers: SURGERY TEAM Page 5 of 7

B. UNDERHAND (Two-Hand Technique)
Let's tie with your "throwing" hand
holding the suture on the "bottom".
Note that the suture is crossed by the
hook. RULE: IF THE THROWING HAND
HAS THE SUTURE ON BOTTOM, START
WITH THE THUMB.
Pass the free end of the suture to the
index finger and thumb of the throwing
hand.
While applying equal and opposite
tension, push the knot down using your
index finger on the suture approx. 1 cm
from the knot.
Transcribers: SURGERY TEAM
Externally rotate your thumb (clockwise
with the left hand) around the suture so
it rests on the lateral part of your thumb.
Lay the free end of the suture across.
Note: it's crossed at the thumb now.
Now pass the free end of the suture
back through the loop.
Cinch the knot down while maintaining
tension in opposite directions, 180
degrees from each other, to minimize
tension on the tissue.
Pinch the TIPS of your thumb and index
finger.
Retract your thumb and pass your
index finger instead. Note that the
tension of both parts of the suture now
rest on the index finger. This constant
tension is one advantage of tying with
two hands.
Grab the free end of the suture with
your non-throwing hand. Note that the
knot is "flat". If it doesn't lie flat, your
probably started this tie with your
thumb while holding the string on
"top".
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IV. INSTRUMENT TIE

Transcribers: SURGERY TEAM Page 7 of 7