In this section, we will teach you the basic components of mental imagery and work through a guided-experience to horizontal mattress suturing. Mental imagery is a cognitive process that involves creating or re-creating an experience in the mind using one or more of your senses (e.g., sight, sound, taste, touch, hearing, and kinesthetic/muscular feel). It can be used for many different reasons such as learning new skills, stress reduction, and building confidence. The ability to form mental images varies individually and can develop with practice.

This cognitive process can be used by learners to learn psychomotor skills more effectively and efficiently. In this section, we will teach you the basic components of mental imagery and work through a guided-experience of horizontal mattress suturing. Through the use of mental imagery, you can become a better technical operator and become more confident in your ability to perform specific psychomotor tasks.

Video[edit | edit source]

Now watch this video of horizontal mattress suturing. The surgeon will place on horizontal mattress suture while describing the technique.

Practice[edit | edit source]

Now it is your turn. Make a 2 cm linear incision on your anterior abdominal wall model. Ensure that your incision does not cut into the fatty tissue. Now, take a suture and close the wound with a horizontal mattress suture. Time yourself as you practice and take note of the time it takes to complete the task.

Image[edit | edit source]

After watching the video and practicing the task, imagine the action of making a 2 cm linear incision on your anterior abdominal wall model. Try to see and feel the image vividly and clearly in your mind as if you were completing the procedure yourself but without actually doing it. As you image yourself through the tasks, think about the weight of each instrument, the rotation of your dominant wrist as you drive the needle through tissue, the slight tension on the suture as you pull it through, and the ease of which the needle pierces through the vinyl fabric. If it helps you, try to close your eyes while you imagine.

Guided Imagery Script[edit | edit source]

You are standing next to the table and the level of the anterior abdominal wall is at your umbilicus. You feel your body get into position with your elbows bent. As you mentally prepare for the task, you take a deep breath and feel a sense of physical relaxation. You are physically and mentally ready.

You feel the coolness of the metal needle driver in your dominant hand as you load your needle and become completely focused on the anterior abdominal wall model in front of you. You elevate the wound edge with cool metal forceps in your non-dominant hand. You pierce the tissue perpendicularly, approximately 5 mm from the wound edge. You remind yourself to pronate the needle driver with your dominant rather than pushing it through the tissue. Feeling focused and confident, you stabilize the tip of the needle with forceps in your non-dominant as you reload the needle driver.

You pull through all but a 2 cm tail of the suture. The tension in your hands relaxes as you realize the ease at which the needle glides through the material. You take another deep breath and are now focused on your second bite through the tissue. Using your non-dominant hand to elevate the opposite side of the wound with the tips of pickups, you pierce the vinyl and this time the needle glides smoothly from the white part to the colored part of the vinyl.

You reload your needle driver and decide for the next two movements, you will intentionally roll your wrist to emphasize pronating through the tissue. You elevate the wound edge furthest from you and pierce the vinyl fabric at a perpendicular angle. As you feel the natural roll of your wrist, you are less worried about creating tissue trauma.

Realizing that only one bite remains, you stand taller. For the last time, you reload your needle driver. This time, you are going to focus on the swiftness of motion. You elevate the wound edge closest to you with forceps in your non-dominant hand. Then, with the suture needle, you pierce the vinyl fabric from the white side. You are confident that your needle entered the tissue perpendicularly and your wrist is gliding through pronation. You see the needle escaping the colored side of the fabric and reload the needle driver to pull the remainder of the suture material through.

All that's left is a simple instrument tie. Something you have done hundreds of times. You pick up the end of the suture that is attached to the needle and twirl it around the tips of the needle driver with small circular movements. You gently pull the knot flat to ensure your suture does not slice through the vinyl fabric. You complete the remaining throws. And reload your needle driver.

You exchange the needle driver for suture scissors in your dominant hand. You cut the suture so that you have 3-5 mm tails. You take another deep breath through your nose and are relaxed now that you see the wound has been well approximated.

Page data
Part of ASAP
Type Medical course
Keywords appendicitis, surgery, suturing
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors Manisha
Published 2021
License CC-BY-SA-4.0
Affiliations Global Surgical Training Challenge
Language English (en)
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