Tag Archives: guts

Suturing & Knot Tying

9 Mar

I was handed the needle driver and pick-ups to suture the skin incision on a woman after a breast lumpectomy.  It probably took me about 5 times longer for me to do this 2 inch incision than it would have taken him.  The surgeon, anesthesiologist, scrub tech and RN are always looking over your shoulder watching you do the entire thing and making it more intimidating.  Everyone wants to show you how to do it better, which really just means show you their way.  And really, everyone just wants you to hurry up so they can get on to the next case.  Breast tissue isn’t the easiest to sew in an older lady, it’s like wrinkly tissue paper – very difficult to confidently approximate.

After I was done my preceptor made sure that I knew I was going to do her follow up visit in clinic so I could check my work.  Two weeks later, I was terribly nervous when I found out she was on the schedule and today would be the day I saw the horrible scar I gave her.  I asked him if I could go see the patient when she came in, him not recognizing that it was the patient I had sutured.  I wanted to see my work, but was really worried to see it since it was the first closure that I had done that was more than just 1-2 knots AND it needed to be nicely closed for cosmetic reasons.  To my surprise, it looked great! I went back to my preceptor, admitted to him my insecurities and told him I’d like to hear what the professional has to say.  We went and saw the patient together and he only had good things to say, success!

Here are some references that I’ve found helpful about suturing & knot tying:

World Health Organization – Essential Surgical Care – basics to suturing
Ethicon Knot Tying Manual – helpful to learn knot tying techniques
Surgical Instrument Catalog – helpful to learn instruments
Knot Tying Videos by the University of Washington  – Great knot tying videos

It’s a good idea to have a basic idea of knot tying, various suture and instruments before any surgery (general surgery, ob/gyn, urology, ENT, etc) and/or ER rotation.

needle driver basic