Step-by-step Procedure to Suture Ligating

• Use one binder clip to attach the wrist of the glove to the plastic container
• Use an additional binder clip to attach the fourth finger to the opposite end of the plastic container
• Use another binder clip to attach the fifth finger to the side end of the plastic container
• Use the last binder clip to attach the second finger to the opposite end of the plastic container

• Open the jaws of your haemostat with your dominant hand
• From the side of the second finger that is closest to you, advance the jaws of the haemostat such that they are perpendicular to the finger
• Advance the haemostat until the entire width of the finger is enclosed in the jaws
• Clamp closed the haemostat
  • Ensure that you have clamped the haemostat such that you hear only 1 click
  • There is rarely a time when operating on human tissue that you will need to require more than one click on any surgical instrument

• Load your needle driver
• Holding the needle driver in your dominant hand, pronate your hand
• Place the needle below the glove
• Line the needle tip directly below the mid-point of the haemostat that is clamped across the fourth finger
• Supinate your hand to push the needle through the glove
• Grasp the needle with forceps
• Release the needle driver from the needle
• Reload the needle on the superior surface of the glove by pronating your hand
• Supinate your hand to pull the needle out of the glove
• Pull the remaining suture until only a 2 cm tail is left on the inferior side of the glove

• Wrap the suture from the superior surface around the needle driver twice
• Open the jaws of the needle driver and grasp the tail of the suture
• Pull your knot tight
• This knot should be placed on the superior surface of the glove

• In the operating theatre, you will need to guide your assistant to help you pass the suture

• The first should be a surgeon’s knot
• Remove the haemostat that you placed across the finger and continue to tighten your knot
  • In the operating theatre, you will have your assistant slowly remove the haemostat
• Now tie the remaining number of knots appropriate for the suture material, ensuring they are square knots

• Ensure the tails are not so short that the knot unravels