One handed surgeon's knot (double throw), the smooth way

This video illustrates how to throw a "surgeon's knot", or knot where the initial throw is looped twice, using a one handed technique.

[@kennethsizer6217]

Thank you for posting this! So many wonderful memories come rushing back. My father was a physician and the first time I saw him tie a one-handed surgeon's knot, I was in complete awe, thinking, "Holy cow, my dad's a wizard!!" Thirty years later, after watching many KZbin videos... "Holy cow, my dad was a wizard!!"

[@lagenteestaloca5875]

This is quite a nice and neat technique, I've been practicing it for a couple if decades... great job at demo'ing!

[@wholeNwon]

Again, thank you for taking the time to produce this excellent description and illustration. It was great fun to learn. I just wish that my own professor of surgery, a renaissance man and much-admired master of technique, were still alive to see this clever feat. By now you are probably a practicing ENT surgeon having a very professionally rewarding career. Time flies, doesn't it?

[@wholeNwon]

In my work, I have absolutely no need to use this technique, yet I'm going to master it just for fun. My own professor was a suturing perfectionist, but I never saw him tie a two-handed surgeon's knot like that. It seems that the situations in which it would be truly useful are limited by attached needles, ligature reels, field depth, actually having both hands free, etc. Nonetheless, I love a challenge. Thanks!

[@brianrethman1144]

Dr. Bevans taught me this a couple days ago, pretty slick

[@mauroge9887]

I'm no surgeon but this is awesome for central venous catheter fixation and showing medical chicanery with the staff 👌👍

[@blade15c]

Got it man! Thanks for teaching me this sir! Was doing it wrong and slow all this while

[@SensiStarToaster]

Elegant. Genius the idea that by throwing simultaneous left and right on your first throw you effectively create a surgeon's knot!

[@soybomb5598]

Outstanding. Thank you.

[@LearningSurgicalTechnique]

This technique is worth learning because it helps to develop coordination between the two hands, but it is hardly ever used in practice because of temporary loss of control over tension of the threads and the difficulty of the technique when wearing gloves. If the needle cannot be cut off from the thread when the surgeon needs to make several knots that technique will create a risk that the surgeon injure him/herself.

[@Matt-bg6kf]

That’s why pop offs were invented

[@johnocallaghan7830]

This is great. Always struggled to learn this one...

[@yaronsaiet893]

Thanks for the great explanation. The next throw should be forward right hand or a backhand left hand?

[@Golden-ts3uc]

спасибо за видео. все понятно!

[@alexlacuata2530]

Hi. I'm an ENT resident as well from the Philippines. Ingenious. Would just like to ask if this methods would be secure in thyroidectomy, specifically in ligating the main blood supplies? I like the economy of motion but trying it out in a simulation, not sure if throwing in 2 - in -1 ties is more secure than doing three separate ties. Thank you!

[@parimaludapurkar597]

This is the one useful video out there!! But the end on the left side of the screen will usually have the needle attached to the suture?

[@bloomclinic9307]

Great!. Thank you.

[@dentalenfield6110]

Thank you !

[@noorzwain6168]

Keep on You doing great job

[@sadammohamed7450]

Thank you.

[@Mahesh-tj4od]

Thank you

[@drmagnus1970]

very nice thanks!

[@sachtej]

Excellent

[@drramanjaneyachowdary802]

Awesome it is

[@mahmoudshaheen5873]

excellent

[@manfrevan6707]

Manos maravillosas

[@rahmanatur4148]

nice information

[@sulaimanalshaar]

whats the appropriate direction of your next knot?

[@MrGstrub]

You just tie a standard one handed throw in the opposite orientation to lock it.

[@djsinghmaharashtr4685]

Both short and long strands moving through loop. What about needle? I meqn long end needs to be stationary. Kindly correct me if i am wrong.

[@MrGstrub]

Sorry it’s not entirely clear...this knot is used for needless suture (pop offs or ties). It can be done if there is a needle attached but you run the risk of getting stuck if you are not super careful. With a needle still on, an instrument tie with a double loop is a better option.

[@muhammadmuaz8735]

sometimes such a knot do not work when we are at a risky area where needle is to be avoided to pass through the loop as both ends are passing throught the loop , the free end and needle end too ? am i correct for my concern? anyone who read it can comment

[@cark4714]

😊

[@globalsmile]

Looks nice but has the inherent risk of needleprick injury unless done at the last suture where needle cut off before tying the knot.

[@MrGstrub]

As noted earlier this tie is to be used with pop off sutures or silk ties. I agree it is not appropriate if you still have a needle attached.

[@Lord-ce2kv]

Way too smooth!

[@rhomanmason8131]

Just wandering! You said one handed knot but used two hands. Am I missing something?

[@MrGstrub]

Sorry if it was misleading...you do need two hands to tie this knot, but the technique employed in each hand is the standard one-handed technique, it just occurs simultaneously such that the result is two throws.

[@rhomanmason8131]

Oh I see know. Great work tho I am impressed.

[@dakotanollner]

@@MrGstrub This was misleading. I tried this on my surgery rotation when they said to show them a one handed tie. Got kicked out of the OR, told to go practice.

[@MrGstrub]

@@dakotanollner if you listen to this video, it clearly states that you must have mastered both a right and left, handed one-handed tie, prior to tackling this simultaneous left and right, handed one-handed throw.

[@charlesbaker3373]

Very nice - except you're pulling the needle through the loop!

[@MrGstrub]

Yes, this technique is best used with pop-off sutures. If you are leaving the needle on, very likely you will instrument tie and then you can just throw two loops to achieve the same result. I rarely hand tie with a needle on.

[@kasamankuru]

exactly...the neddle

[@nickjimenez9983]

R u using 2 hands

[@MrGstrub]

Yes, you use two hands and employ the standard "one handed" technique in each hand.

[@markcollins8326]

LigaSure - no knots ever

[@wafa6109]

It's not one handed.. That's two handed sir

[@TheBilliardsDoctor]

This is two handed....

[@AlexJoseph-jy5bc]

Are you a keener medical student? An ER resident? Any surgical resident would know that the entire purpose of a one handed knot is to increase efficiency. In a true one handed knot the right hand rotates the needle driver w/ needle through the tissue, then the left hand throws the knot and cinches it down -- the needle driver stays in your right hand at all times and NEVER has to be dropped onto the field. You are immediately ready to place the next stitch. In your described "one handed" technique both hands are actively involved in tying the knot and the needle driver must be protected/dropped/picked up/unprotected before you are ready for your next stitch. Your video actually describes a two handed technique. However the traditional two handed technique is simpler, faster, and requires fewer movements. Your technique has poor economy of motion.

[@obcane3072]

Alex Joseph You don't use this technique with sure attached to s driver. You use it with free ties. Learn the knot before bashing and you'll appreciate it's elegance as well as economy if motion.

[@AlexJoseph-jy5bc]

If you are using free ties, you're tying off a vascular pedicle. You should never use a one handed knot on a pedicle. I don't expect you to understand this as you're an obstetrician (and would probably just use a ligasure).

[@MrGstrub]

Well Alex Joseph, thank you for sharing your wit and knowledge. I am an otolaryngologist (which I believe I state in the video, but perhaps you ignored that in order to make your snarky opening seem relevant). I can only deduce from your comments that you are not a "keener medical student" or ER resident, but I will not insult other physicians by stereotyping you into an obviously disgruntled specialty that I am sure brings joy to your co-workers on a daily basis. We otolaryngologists know the type. This technique is not meant to replace the needle driver technique you describe. The video describes a method to simultaneously throw, using both hands as you keenly point out, two "one handed" knots so that the net result is a traditional "surgeon's knot." Your comment that it should not be used for a vascular tie is incorrect, as it produces the same knot that a traditional two-handed surgeon's knot produces, but with more elegance and economy of motion (despite your claim to the contrary). This is a specialized knot to be used in the appropriate situations. For example, if I am insetting a radial forearm flap, I use dozens of pop-off vicryl ties. I also use pop-offs for closing the deep layers of large incisions. In these circumstances I employ this knot and can perform these tasks in nearly half the time. I'm sorry if you have no use for this technique, but I can assure you it does have its applications when used correctly.

[@emmoiv]

@@AlexJoseph-jy5bc Alex you're a PA right?