THE SURGEONS TECHNICAL SKILL IN SUTURING - AN ANALYSIS OF THE ACTUAL SUTURE TRACKS

Ideal suturing was defined as advancing a needle along its curvature ( needle circle) to minimize tissue trauma, while placing the suture wit h its intended span and tissue bite in the expected place. Actual sutu re tracks were analyzed to find the keys to produce such suturing. Cor respondence of those tracks to the ideal track was then determined by the span, the initial needle angle (IA) into the tissue, and the cente r of the needle circle. Eight surgeons with 4-7 years of experience pr oduced 22 ideal sutures in two types of tissue simulants: The entrance and exit points of the needle were level in flat suturing, while the entrance point was slanted 45 degrees for slant suturing. The correspo ndence was better with slant suturing than flat suturing (P < 0.01). T he IA in flat suturing was 49.0 +/- 2.0 (mean +/- SE) degrees versus 3 3.0 for ideal suturing (P < 0.01), while that in slant suturing was 35 .5 +/- 1.9 (P: ns). In conclusion, the IA was the key to good results, and was optimized in slant suturing, which was instinctively utilized in practice by using forceps. The forceps avoided a derangement of su turing stemming from the configuration of the needle employed and from the range of motion of the surgeon's arm (human engineering), while s atisfying the surgeons inclination to take a large IA.