Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom.
Surgeon. 2020 Dec;18(6):e21-e26. doi: 10.1016/j.surge.2020.04.006. Epub 2020 May 20.
This is a discussion about correct suturing techniques and implications that follow inappropriate suturing. We deconstruct the suturing needle angles and methods to be adopted to acquire the perfect needle angle to the tissue being sutured. A study of angles confirms that 90° is perceptible to the naked eye and easy to identify, making it an appropriate foundation to explain, communicate and teach the concepts in the wet-lab and the operating room.
There is a lack of robust teaching regarding entry of the needle orthogonal to the tissue planes. In addition, objective methods of assessing angles of the needle relative to the tissue and consequences of inaccuracy are lacking. The authors aim to deconstruct the steps of suturing with the aim of demonstrating ninety degrees is the perfect suturing angle.
We conducted a study to identify 90° (the perfect suturing angle) as an angle easy to identify with the naked eye. Angles from 86° to 94° and 41° to 49° were printed and presented to volunteers with the instruction to identify the angles of 90° and 45°.
Fifty-one volunteers replied to the 90° angle study and sixty-five volunteers replied to the 45° study. 92% correctly identified at least one 90° angle and 72% identified both the 90° angles. 63% identified at least one 45° angle and only 27% identified both the 45° angles presented to them. This supported our hypothesis that 90° is an angle that is readily identifiable to the human eye.
Objective assessment of surgical skills and training should focus on the basic needle skills with particular emphasis on suturing angles, progressing to higher skills using low and intermediate fidelity models and correlating practice alongside the trainees' operative progress.
本文讨论了正确的缝合技术以及不当缝合所带来的影响。我们剖析了缝合针的角度以及需要采用的方法，以获得与缝合组织完美匹配的针角。通过对角度的研究可以证实，90°是肉眼可识别且易于辨认的角度，这为解释、交流和教授湿实验室和手术室中的概念奠定了合适的基础。
目前，缺乏对垂直进针入组织平面这一正确入针方式的有力教学。此外，缺乏评估针与组织之间角度的客观方法以及评估不准确角度的后果。作者旨在剖析缝合的各个步骤，以展示 90°是完美的缝合角度。
我们进行了一项研究，以确定 90°（完美缝合角度）作为一个易于用肉眼识别的角度。我们打印了 86°至 94°和 41°至 49°的角度，并向志愿者提供了指示，要求他们识别 90°和 45°的角度。
51 名志愿者回复了 90°角度研究，65 名志愿者回复了 45°角度研究。92%的人至少正确识别了一个 90°的角度，72%的人正确识别了两个 90°的角度。63%的人至少正确识别了一个 45°的角度，而只有 27%的人正确识别了呈现给他们的两个 45°的角度。这支持了我们的假设，即 90°是一个易于被人眼识别的角度。
手术技能的客观评估和培训应侧重于基本的针具技能，特别强调缝合角度，然后使用低保真度和中保真度模型来提高技能，并将实践与学员的手术进展相关联。
