Basic Surgical Skills

Indonesia 2018
 SAFETY FIRST !
• NEVER DIRECTLY HANDLE SHARPS WITH YOUR
FINGERS (i.e. blades or needles)
• Pass sharps in a kidney dish to your assistant /
nurse
• Safety of all is responsibility of operating surgeon
• Always dispose of sharps in a sharps bin
− not on patient or operating table!
• In case of injury
• assess the injury
• assess patient status
 Handling Instruments
Basic Principles:

• Safety
• Economy of movement
• Relaxed handling
• Avoidance of awkward movement
 Handling Instruments (cont.)
Cutting Instruments:
• Scalpel
- attachment
- detachment
- holding - like a table knife
- like a pen
- cutting
- passing the scalpel in a kidney dish

• Scissors (2 types) - holding

- cutting
 Handling Instruments (cont.)
Holding Instruments:

• Forceps (toothed and non-toothed) - holding

• Artery Forceps

• Needle Holders
 Knots
• Knot-tying is a fundamental technique in
surgery, and is often performed badly

• Take time to perfect your knotting technique

• Uses of knots:
− Tying sutures
− Ligation (tying vessels)
 General Principles of Knot-Tying
• Firm and unable to slip
• Small, to minimise foreign material and
foreign body reaction
• Don’t ‘saw’ the material – it will weaken the
thread
• Don’t damage it by grasping with instruments
except at the free end
 General Principles of Knot-Tying
• Avoid excessive tension
• Avoid tearing tissue
• Apply tension horizontally

The standard knot used in surgery is the

reef or square knot, with a third throw for security.
- Alternate tying ‘index finger’ knots and ‘middle
finger’ knots at the same time as the hands
cross over for each throw
 Types of Knots
• Reef / Square Knot - one hand
- two hands
- instrument tie
• Surgeon’s Knot - one hand
- two hands
- instrument tie
• Slip Knot - must always be followed by a
reef knot
Square ( Reef ) Knot
 Secure Knot

Secure knot
Standard > 3 throw for
knot tying multifilaments
> 6 throws for
monofilaments
Surgeon’s knot
 Handling Sutures
• Tension – attempt to remove all elements of
tension from any anastomosis
• Insert needle at right angles to the tissue and
gently advance through the tissue, avoiding
shearing forces
• As a rough rule of thumb, the distance from the
edge of the wound should correspond to the
thickness of the tissue
• Successive sutures should be placed at twice
this distance apart, i.e. double the depth of
tissue sutured.
•
 x (tissue thickness)

x 2x

•-same distance apart

and same distance
from edge
 Interrupted Suture

x
x

x
Interrupted Suture
Long wound : half – half

Ellipse : start from either end

Linear Incision Closure

3 2 3 1 3 2 3
Ellipse

≥3X
 Ellipse

•X
•≥3X
Closure of Ellipse
 Handling Sutures (cont.)
• All sutures should be placed at right angles to
the line of the wound at the same distance from
wound edge and same distance apart in order
for tension to be equal down the wound length

wound
edge parallel, same distance
apart, same distance
from edge