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Ethicon-Knot-Tying-Manual.pdf
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DEEP TIE

Tying deep in a body cavity can be difficult. The square knot must be firmly snugged down as in all situations.

However, the operator must avoid upward tension which may tear or avulse the tissue.

 

 

 

 

 

1

Strand looped around hook in plastic cup on

2

Purple strand held in right hand brought

Practice Board with index finger of right

between left thumb and index finger. Left

hand which holds purple strand in palm of

hand turned inward by pronation, and

hand. White strand held in left hand.

thumb swung under white strand to form

 

 

 

 

the first loop.

 

 

 

 

 

STEPS 1-4

241

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

By placing index finger of left hand on white

Horizontal tension applied by pushing down

strand, advance the loop into the cavity.

on white strand with left index finger while

 

maintaining countertension with index finger

 

4 of right hand on purple strand.

DEEP TIE

 

 

 

 

 

5

Purple strand looped over and under white

6

Purple strand looped around white strand to

 

 

 

strand with right hand.

 

form second loop.This throw is advanced

 

 

 

 

into the depths of the cavity.

 

 

 

 

 

STEPS 5-7

261

 

 

 

 

 

 

 

 

 

7 Horizontal tension applied by pushing down on purple strand with right index finger while maintaining countertension on white strand with left index finger. Final tension should be as nearly horizontal as possible.