Techniques for better suturing.

Suturing techniques enhancing the accuracy of suture placement and reducing the forces on the tissue being sutured were evaluated in six surgeons, each with 6 years' surgical experience. The accuracy was assessed by the distance between the actual and designated needle exit sites. Force was expressed in terms of the torque on the needle holder using a maximum of the torques (max. F), maximum derivative (dF/dt) and integral (IF). The effects of four factors (suturing techniques) on suturing were evaluated: (1) placement of the needle holder on the needle; (2) inclining the tissue at needle entrance, as is commonly done by elevating with forceps (unnoted role of the forceps); (3) adjustment of the needle's exit during suture placement, as is unknowingly employed in practice, and (4) variation between individual surgeons. All these factors affected the accuracy and force of suturing. Gripping the needle closer to the tip strongly reduced the max. F, dF/dt, and IF per time, as did inclining the tissue. Adjustment of exit improved accuracy, but has the potential for causing avoidable tissue injuries. Differences between surgeons suggest the necessity of addressing fundamental surgical techniques and formally incorporating them into the training programme.