Surgeon Explains How to Apply Stitches | WIRED

you're shaking what's wrong with you I'm nervous good I'm Annie Onishi Annie is a trauma surgeon she's explained operating rooms and surgical procedures in technique critique as I tell my medical students vitals are vital we always talk about them we always want to know what they are and yes we ask what they are on the regular and I'm Peter Reuben Peter is a wired contributor who covers culture and technology annie is going to teach Peter how to suture and tie surgical knots using different materials ranging from easy to difficult hey Peter you want to know about surgical knot tying and suturing technique got time I cross it off my bucket list let's get you a distance Grubbs excellent the first thing we'll learn today is surgical knot tying how much does this have in common with tying a friendship bracelet this is a hundred percent the same activity as tying a friendship bracelet oh my god I'm gonna get the marshmallows let's do this so typically medical students will learn this during the first few days of their surgery rotations and it's an activity that's mastered over hours and hours of practice there's actually two types of knots there's the two-handed knot and the one-handed knot today I'm going to be teaching you the one-handed knot because it's easier turns out it's not easier it's just more applicable in general practice this is a knot that we tight everywhere whether it be we're fixing the inferior vena cava during a major trauma case you're sewing little arteries on the heart or even things as simple as you're closing skin of a little laceration in the emergency room it's all the same knot so Peter to help you learn that tongue today I brought you the surgery resident starter pack so is this like an official training tool is this what people are gonna start using in med school this is pretty darn official when students are first learning how to tie knots they use multicolored large-bore yarn just like this the reason the color is helpful it will show you that your knot is lying perfectly as you tie it and a one-handed tie there's actually two knots there's a forehand throw and a backhand throw alright so what I'm gonna do I'm gonna take the white string and hold it in my left hand so that my purple is crossed see that okay my forehand throw has an overhand grip like this like you're riding the pony okay can you ride the pony the pony so with your strings crossed you're gonna create a four shape do you see the four do now your index finger is going to go through the four and loop this tail and bring it through the four just like that the whole thing the whole tail through whole tail through now with your right hand and your left hand you're gonna put the knot down and it should be nice and square that's excellent Peter good I'm a doctor you're a doctor so that's your forehand throw okay now for your backhand throw left hand comes back to neutral position with the right string adjust your grip on the purple string to a karate chop grip okay now use your middle finger to get the tail through the floor what's maintaining tension on that maintaining tension and bring it bring it through oh now you need to cross your hands okay so let's try it again okay and then you alternate forehand back in okay where are you likely to use this sort of not change so this is a knot that we tight everywhere whether it be we're fixing the inferior vena cava during a major trauma case you're sewing little arteries on the heart or even things as simple as you're closing the skin of a little laceration in the emergency room it's all the same knot it's just a matter of what you're tying what kind of suture so you are doing this as a chain now depending on the suture material you're using the most knots you would ever tie is like eight or ten okay now here's without fries here's the difference between menu look where your purple strands first work wear my purple string is our you gotta remove all and and that's gonna give you a little bit of tension to make this guy easy but I still got ham hands you're gonna do it you're these can't be hand pin check this out oh my god one hand my god I'm gonna hire it just like the Nathan not great I look at yours and I see friendship friendship and here I see rancor and years of bitterness so I have a feeling that the answer to this is going to be everything but what am I doing wrong I think the problem is coming as not is going down you're not applying even tension so your knots are ending up stacked instead of square when we teach the medical students how to do this they're just doing it constantly they you can find little strings tied to everything the the mouse the computer their pants oh yeah you really don't have to do much when you cross back over to the floor hand do yours that you got it done now what happens when the ends start getting short then you're done I'm done right this is good to learn the mechanics of the knots this is this doesn't sit like real suture so why don't we move on to something more difficult I actually brought some suture material to show you okay so the way that suture is labeled is 0 is sort of the middle set point and something like a six though is tiny tiny that's that means six zeros all in a row the easiest thing to tie is Oh silk and is six over the finish you can use absolutely not it goes all the way down to like ten oh but that's used on very fine things like a vein or an artery or a nerve so for you Peter we're gonna use sort of the elementary school Oh silk this is the same exact thing as your yarn but what's gonna make this a little harder is that your sutures finer so you're gonna have to work harder to keep good tension and to make it sit nice so again the mechanics are the same if it's really important that you sort of follow the knot down with your finger to get the not to sit exactly where you want it to sit all right Peters let's see so I had this forehand throw mhr again and use your oh yes you see how your that was very instinctive what you did you your hands sort of crawled up the suture that's it that's perfect karate chop I called it now in my brain this is ham hands because I have ham hands oh you have beautiful hands you have healing hands so Peter I actually think you're ready for the next curve ball oh boy which is let's get you to do this with gloves on so there's no like in-between it's going from the training wheels to the Grand Prix okay so do doctors actually do the thing where they're like yeah let's do this 100% every time let's do this then okay so let's get started so Peter this is just gonna be the same thing same knots but I just want you to get a sense for how it feels different when you can actually you know feel the suture material directly on your skin it's almost like numbness Wow hey guess what I'm even more terrible I didn't think this was possible hmm that's not the size you like to hear just interesting many different people it's the other thing you like to hear will be didn't that's interesting every different person makes their own unique mistake your euphemisms are the best keep going you're doing great okay what would you got on there in real life your hands are wet oh hey um okay so this is what like the bodily fluid my choice of my choosing it's actually silk because it's a braided suture doesn't make too much of a difference yes I thought it would be a lot worse if I give you a monofilament which is like a plastic one strand that will be harder with your hands wet but you're doing really good yay yeah you really I think mastered the mechanics of the knot tying you would just need some polishing in terms of your tension you're not placement what's gonna be next here what are we gonna do so I have just the thing have these creepy skin models with a bunch of different types of incisions it's solid and it's kind of a little giving but it's dense it feels real so I have for you here a suture kit and a 400 bison on a cutting needle and a cutting needle is what we use to close skin with this is an absorbable monofilament okay for oh so that's a little smaller than you've been working with so the first thing you have here is a needle driver and every surgical instrument locks in place so practice that mechanism and then real surgeons don't put their thumb in that hole push it with the body or hand and then close it and then you also need these pickups these are rough approximations of ads and forceps with teeth so these have teeth on the end of it that help you grip skin these aren't Weezer these are not tweezers these are called pickups pickups and then that's the needle now so be careful and you're gonna oh you put your thumb in the hole just for that part hypocrisy good take the whole thing out wait wait wait wait wait wait wait wait okay okay so now the way to properly hold the needle use your pickups to help you so I'm gonna hold my needle halfway back mm-hmm at a 45 degree angle here and at the very tips of my needle driver all right so now we're ready to close skin so what I'm gonna teach you now it's called the running subcuticular closure okay say it with me running subcuticular okay and this is a nice way to make the skin come together and there's no stitches visible okay so I'm gonna pick up the edge of the knife quote-unquote skin take one bite sort of right in the apex of this skin is by it also it is I'm gonna then what's called protect my needle so now the sharpen the needle is protected against this bone okay and I'm just going to do a couple of one-handed ties usually three or four for this I'm alternating and then when you get to the end I'll show you what to do do you want to try no but I guess I have to I want to keep it you expose like me there sure sure there we go back to the failure release your release your needle driver I don't know yep exactly push it from behind cuz you don't usually want to touch the tip of this you only don't either break air make it dull so now we're gonna do is protect your needle that's it perfect pull through good and now you're ready to tie do four single-headed throws like you learned okay okay now the color of the skin and the color of the filaments yeah there is not a lot of contrast going on here can I cheat I'm just gonna help you none so cuz the point of this exercise is just so nuts oh yeah you're getting so good I'm so proud of you I'm doing good alright so we're gonna pretend that I did that and now it's anchored yep so then a running subcuticular closure if you use your imagination is good end up like a series of seas in the plane of the skin so then your next bite you're going to avert the opposite side of the skin you're gonna enter the tissue sort of exactly opposite to where you came out and again you're just going to kind of run along the dimension of the skin just like so you're gonna use the back of the needle to push it along and if you're super slick you'll load your needle while it's held down there for you hmm and so the only knots are really two exactly it's just kind of ring it together like that so you're gonna pick up on this side but I did it that way that's okay so turn your body so yep that's it so when you're the operating surgeon you can hip check people you have to get yourself comfortable out my way there's a patient on the table okay so you're actually gonna come along this dimension okay again use your pickups to grow the tissue where you want it to go and you know in real subcuticular tissue you want to come out inside the wound so the petition so that this stitch gets hidden but that's okay purposes that's your first bite that's not the point of this closure is that you don't see any suture so am I going across where am I going along no now you're going across again use your pickups to show yourself where you want to go so move along make more progress which means take a bike with your pickups closer to your body again and I come across the tear right but this is in this dimension so right right and now with this hand push the tissue there you go that's perfect great yeah all right videos over let go pull this out oh no no but at this rate it's gonna heal before you yeah yeah yeah even if they don't look perfect these tend to heal up okay but you can make this look like nothing ever happened which is kind of it which is not what's happening to your patient oh well they're gonna have a nice memento of their time that's right all right so let's assume that the rest of this is gonna go flawlessly like that like this like this so Peter once you get to the end you're gonna close this with what's called an Aberdeen hitch okay take the post again we're protected here get your right hand through that loop and you're gonna go grab your post and bring it through you're not don't don't let your loop get too small oh okay okay so I got one good dude all right yeah keep tension on the post don't let the loop get too small pull on that that'll go down well just the bottom one just this one there you go just that bottle I'm good and then one more put that whole thing through yes nice very good oh no okay good work too soon okay now reload your needle all right so now you're gonna bury this knot so just take a bite like behind it and come out over here don't want you virt like that holding your pickups like that come on baby oh oh no no oh God so just pick this at the time at this point the patient has healed maracas oh there's a wake as thanking me profusely I'm ready to be discharged Tom good your assistant cuts this and then once you're done with the suture you pass it off to the scrub protect and you say a needle back needle back thank you what comics look how beautiful that is the thing you did 80% of the point of this is that the suture is hidden so they don't need to get them removed and that they just dissolved all right Peter are you ready for the next lesson yes please okay nurse bring in the patient's I've never seen anything quite like this doctor most severe case I've seen yet all right what are we gonna do with this I think there's already a some sort of thing going I see a little bruise well I think first we'll make a little laceration then we'll close it up sometimes you have to hurt things to heal them so true two bananas were harmed in the making of this video yeah and is this what how you would make an actual incision oh no normally an incision is with a firm hand in a straight line and just all the way down yeah it just depends on what kind of operation you're doing and then so where would you see this this is in a skinny guy like you in little hernia wonderful yeah well let's just pretend I'm stitching up my oning there you go okay so for this particular model it's best to close a banana laceration with a simple interrupted nylon sutures orthopaedic surgeons will use the ER Doc's will use it but it's sort of a simpler more straightforward way to close okay so this is just gonna pick up on the skin take a nice bite come right across so how much room should I leave behind for the night um you want to poke through because you're gonna put a couple of these in so and then which is my post is this my post yes particular protection needle so the filament that we're using what kind of great isn't it so this is a 3o nylon so nylon is a monofilament non-absorbable suture and 3oh is slightly larger than the four oh you were just working with all right so we got it not yet so then I would actually trim your tails and you would put in a separate knot that's the interrupted Oh each time as opposed to running so as you can see I did what you did and then cut my tails and I started again this is called an interrupted closure that trim the tails start over all right what are you pickups doing right now two hands what are your pickups done you're gonna wrap it back careful yeah okay so when it's really short something that the orthopods and the ER Doc's do but the general surgeons don't do which is called an instrument tie so it's the same knot but you're just gonna do it what with your instrument and again general surgeons don't usually do this why don't you show me that one because it's cheesy and it's not nice and it's not delicate and it's not it looks similar it is easier but it's not civilized so I mean you've got the basic skills down the knot tying the suturing I think the things that would get built up to be a little bit more realistic is a wide open body cavity blood everywhere everyone's yelling patient's not doing well you're really nervous you're exhausted that's probably a little bit more really this is suboptimal skin condition indeed yeah your resident may have to redo your skin closure on this one bite injury some patients are more difficult than the others I wouldn't take it too personally well Annie thank you for taking the time to show me all this stuff may it never come in handy I'm glad that they're people like you to make sure that it does should always shake hands with your assistant before you leave your that is what that is [Applause] [Music]

Channel: WIRED

Views: 3,174,647

Rating: 4.9477978 out of 5

Keywords: annie onishi, annie onishi interview, annie onishi wired, annie onishi surgeon, surgical knot, surgical knots, surgical knots wired, surgical knots surgeon, surgeon explains surgical knots, wired surgical knots, surgery knot, how to make knot surgery, surgical knot technique tutorial, sutures, surgeon explains, surgeons reacts, surgeon reacts, wired surgeon, surgical resident, how to do stitches, stitches, surgical stitches, stitches technique, how to give stitches, wired

Id: d-yWx772qFU

Length: 17min 1sec (1021 seconds)

Published: Wed Nov 27 2019