1. Suture Laboratory Dr. Otto Lanz Diplomate ACVS Dr. Otto Lanz Diplomate ACVS

2. Tissue Forceps  Function As Extension  Thumb  Opposing Fingers  Pencil Grip  Only Acceptable Grip  Widest Maneuverability  While Not In Use  Palm Instrument  Flexing the Little, Ring, and Middle Fingers

3. Tissue Forceps  “Use” to “Hold” Position  One Motion  Easier to Perform  Palms Down  Gravity

4. Needle Holder  Holding Instrument  Thumb and Ring Finger  Index Finger Supporting the Shank of the Instrument  Needle Positioning  Very Important  Perpendicular to the Needle Holders

5. Positioning Needle  Grasp Needle  Near the Eye  Midpoint  Near the Point  Best Position  Midpoint  Less Risk of Bending Needle

6. Driving The Needle  Curved Needle  Two Forces  Driving Force  Rotating Force  Position of Surgeon  Comfortable Body Attitude  Turn Your Body to Some Degree

7. Suturing  Start With the Far Side of the Incision  Gently Grasp the Tissue  Tissue Forceps  Retract Tissues  Upward and Outward  Don’t Block Vision With Tissue Forceps  Move Your Hands  Not Your Entire Body

8. Suturing  Focus On a Spot  5 mm From the Wound Edge  Drive the Needle  Continue Holding Tissue With Forceps  Release Needle  Extract the Needle  Needle Drivers  Rolling Your Wrist

9. Suturing  Following Extraction of Needle  Support Needle with Forceps  Re-grasp Needle  Midpoint  Perpendicular  Repeat Process  Near Side

10. Suturing  Properly Maintain  Excess Suture Material  Needle  Thumb and Index Finger  Make a Loop With Excess Suture  Place Loop in the Palm Of Your Hand

11. Knot  Four Throws  Square Knot  Role Your Wrist  Dominant Hand  Make Your Throws  Properly Cut Suture  Prepare Operative Field  Next Stitch

12. Cutting Suture  Long or Short Tags  Blunt  Long Tags  Taper  Short Tags  Rotate Wrist  See Suture  Before You Cut