The surgeon's technical skill in suturing: an analysis of the actual suture tracks

Ideal suturing was defined as advancing a needle along its curvature (needle circle) to minimize tissue trauma, while placing the suture with its intended span and tissue bite in the expected place. Actual suture tracks were analyzed to find the keys to produce such suturing. Correspondence of those tracks to the ideal track was then determined by the span, the initial needle angle (IA) into the tissue, and the center of the needle circle. Eight surgeons with 4-7 years of experience produced 22 ideal sutures in two types of tissue simulants: The entrance and exit points of the needle were level in flat suturing, while the entrance point was slanted 45 degrees for slant saturing. The correspondence was better with slant suturing than flat suturing (P < 0.01). The IA in flat suturing was 49.0 +/- 2.0 (mean +/- SE) degrees versus 33.0 for ideal suturing (P < 0.01), while that in slant suturing was 35.5 +/- 1.9 (P: ns). In conclusion, the IA was the key to good results, and was optimized in slant suturing, which was instinctively utilized in practice by using forceps. The forceps avoided a derangement of suturing stemming from the configuration of the needle employed and from the range of motion of the surgeon's arm (human engineering), while satisfying the surgeons inclination to take a large IA.