Suturing techniques for a restricted operating space.

The movements of the needle holder and the needle do not correspond when the needle grip is modified for suturing in awkward sites. In this study the range of movement of the needle holder was determined for three modified grips and the optimum suturing methods were determined for horizontal and vertical suturing fields and for restricted and open operating spaces. Gripping a needle obliquely resulted in a 90 degree counterclockwise rotation of the range of movement of the needle holder. Gripping it after rotation deviated the needle holder without altering the range of movement. A combined grip achieved by rotating after shifting had an intermediate effect. The optimum suturing for a restricted horizontal operating space was to use a half-circle needle in the first half of its range of movement with the rotated grip. With the oblique grip the last half of the range should be used and in the middle the combined grip is used although gripping the needle is most stable with the oblique grip. For a restricted vertical operating space, the third quarter of the movement range was allotted to the rotated grip and the last quarter to the combined grip.