Refinement of a surgical technique using angulated needle holders and surgical instruments

Surgical techniques can be refined and dexterity improved by using angulated needle holders and instruments. This allows the surgeon to place his or her hand in the position of function while suturing either retrograde or antegrade, thus permitting flexion, extension, abduction, adduction, pronation and supination with circumduction to occur without restriction. Under normal circumstances abduction, pronation and extension are limited by anatomic factors, such as the greater mulitangular abutting the longer styloid process of the radius and the stronger ulnar collateral ligament restricting abduction. The chief indication for using angulated needle holders is in retrograde suturing, such as placing posterior row sutures in anastomosing blood vessels, intestine and the ureter. These instruments are not substitutes for straight needle holders but are chiefly an adjunct that permit the surgeon to perform movements with his hand at the wrist joint that are not allowed with the use of straight needle holders which require greater torque in performing operative procedures. They allow better exposure by improving visibility to the area being sutured since the surgeon is not looking down the barrel of the needle holder and has a clear unobstructed view. The instruments permit clamping and suturing of tissues and vessels in small deep wounds that do not readily admit nonangulated hemostats and needle holders, such as those in urologic and gynecologic operations. Instrument tying is easily accomplished because of the short shaft of the instrument, especially in plastic or surface surgical procedures. Furthermore, with angulation, one is able to grasp the needle holder between the thumb and volar aspect of the second and third digits, thus allowing easy retrograde movements that one experiences in grasping a thumb forceps. From the standpoint of medical egonometrics, hand fatigue is reduced since the needle holder does not have to be locked by closing the rings and engaging the serations each time the needle is handed to the surgeon for placement of sutures.