Surgical Knot Tying - Two-handed, Righty

What's up everyone today ?

I'm going to be teaching you how to tie a two handed surgical knot .

And this video is specifically for people that are right handed to start .

I like to have my incision pointing away from me .

We're gonna pretend that the needle is attached to the purple side .

So we're gonna take our needle driver in our right hand , grab our needle and throw our stitch .

Needle ends up on the left and the right end , the free end ends up on the right now to start tying this knot .

I like to grab the strings of what I call the pistol grip .

You're gonna grab onto it with your bottom three fingers and you're gonna hold your hands in the shape of a gun with your left hand , the side that's holding onto the needle .

You're gonna form a ring around the string with your pointer and your thumb .

And you're gonna start by rotating the ring away from you .

When you open the ring , you can see that .

Now this string is looped around our thumb .

We're gonna take the free end and loop it around our thumb in the opposite direction .

You can see that we form a loop .

We're going to reform the ring by pinching our fingers together and rotating it a second time .

Now , towards us , you're gonna grab onto the free end , rotate it a third time away from you and you can pull the free end through the loop that you created .

You can see that we've tied a nice overhand knot .

The next step is to pull it tight .

So there's your first knot .

Second knot is gonna start the same way with the pistol grip .

You're gonna form the loop .

Last time we rotated it away from us .

This time , we're gonna rotate it towards us , looping it around our pointer finger .

We're going to take the free end and loop it around or point your finger in the opposite direction again , forming the loop , reform the ring , rotate it a second time away from you and grab onto the free end .

We're gonna rotate it a third time and push the free end through the loop , tying an overhand knot .

And we pull a tape .

You can see that we get a square knot .

Now , it's important to tie square knots because they don't slip .

If we tied the same knot twice in a row , we would get a grainy knot , which is bad because they do slip .

So it is important to alternate which way you start either with your thumb or with your pointer finger .

Now , it's also important to keep straight is the direction you're pulling your strings .

It's kind of easy to tell with this thick string , especially one that's multicolored .

But when you're tying with suture material that's all black and too small to see you really have to know based on your hand position .

So when we go through the second knot , I'm really gonna emphasize which way to pull the strings to keep them straight .

So let's go ahead and tie next knott .

Start with a pistol grip , form your ring .

This time we're gonna start with the thumb .

Make your loop , rotate it a second time .

Grab the free end , rotate it a third time and pull the free end through .

Now , this left hand is holding onto our needle .

So this hand is not gonna move too much .

What it's telling me is that since we started with our thumb , it's telling this side to come towards me .

So when I tighten my string , I'm gonna pull this side towards me .

Now let's tie the next knot .

Start with the pistol grip form your ring , rotate it once loop , it rotated a second time , grab the free end , rotate it a third time and pull the free end through .

Now , we started with our pointer finger .

It's telling this hand the free end to go that way to pull it away from you .

When I pull it away from me , you can see that I get another awesome square knot .

You can tell that everything is lined up perfectly because the white string is on the left and right and the purple comes down the middle .

So this uh let's just tie one more third knot to really drive this point home form your ring .

We're starting with the thumb a little bit rotated .

A second time , grabbed the free end rotated a third time .

Pull the free end through , start with the thumb , pull the free end towards us .

And the last one form your ring , first rotation over your pointer finger , second rotation , grabbing the free end , third rotation , pulling the free end through .

Start it with the pointer finger , pull it away from you .

This is three square knots on top of each other and this is exactly what you want .

So that is how to tie the two handed surgical knot for people that are right-handed .

Um If you stick around , I have a couple quick tips for you .

You might see some videos online or even hear some attendants who tell you to cross your strings before you start tying your knots or to when you're pulling your strings to , to cross your hands at , at certain points .

And this is confusing .

Um I'm gonna show you why .

So after you throw your stitch , you're gonna see some videos that tell you to cross your strings in the beginning .

Now , here's your first problem .

We took our needle and we just whipped it around , probably stuck our teammate .

So that's the first mistake that I don't like doing .

Now , the reason they do this is because when you tie your first knot , you can pull your strings to their respective sides and you get a nice overhand knot and this looks nice .

But in order to tie this knot , we need to throw our needle and cross our strings to start .

Now , for the second knot , if we pull the same side , everything's gonna get tangled up .

Now , we have to cross our hands in order to tie a square knot .

This kind of hurts my shoulders .

I'm getting confused and I don't like doing this .

So by crossing our strings in the beginning , we threw our needle , crossed our strings and crossed our hands all to tie one square knot .

If you follow techniques that I showed you , your needle never moves , you never cross your strings and you never cross your hands and you get perfect knots every time .

Now , um somebody might wonder , well , what do you do if the incision is horizontal ?

Well , let's find out .

So now we have our incision that's horizontal .

And uh you know , if you follow the techniques that I showed you is this shouldn't matter .

And I'll show you .

Let's start with our technique .

So we have our pistol grip , we're tying first with our thumb , start it with the thumb , pull it towards you .

We got a good square knot .

Now , we're gonna start with our pointer finger pull it away from you .

So by following these simple rules , it doesn't matter which orientation the incision is in , you're still gonna get good square knots that hold it closed .

An easier way .

What I said in the beginning is just orient yourself .

If you want to lean over your patient or just move so that the incision is now pointing away from you .

Um This will put you in a position that you're more comfortable in .

This will be important in the or when you have a lot of pressure on you to tie good knots , you really want to make sure that you're comfortable and know what you're doing .

Um So that's it .

Uh This is gonna take lots of practice , so feel free to watch this video as many times as you like , please share it with your friends .

Um And thanks for tuning in .

Good luck .