Tying up a pedicle to be transected by combining them is facilitated by using ties on passers, and can be performed efficiently by doing the following method.
Step 1. The surgeon will then place an angled clamp under the pedicle & then will open the jaws as it shows on the other dies of the tissue. The nurse then places a tie on a passer, then with your free hand hold taut between & the clamp in the other, all the way down the angled clamp's jaws. The surgeon grasps the taut section of ligature with the angled clamp. When grabing a taut segment, instead of a free end dangling below the passer, the operators hold control of the ligature.
Step 2. The surgeon will then take a brief moment to pause until he notices that the ligature has been let go, before pulling it through. Pulling and clamping the ligature all in a solo motion prior to it being released results in a torn pedicle that proves both disgraceful to the operators & could be hazardous to the patient.
Step 3. The surgeon places his free hands in 1 hand, this then leaves the assistant with both her hands free to go pass the 2nd ligature and right into the angled clamp's teeth.
Step 4. The assistant retains the 2nd ligature and ties his side first. Light retraction near the acceptable course of 1 ligature this may help keep the seperation between the two while the other one is being tied. Countertraction during tying of 1 ligature may sometimes be aided when grasping the other end of the ligature deep in the wound with a medical instrument & correctively guiding its tension.
To have good distance in between the two ties, the first half hitch is from the knot tier, then prior to tying it down, places his two index fingers inside the loop. Take the deep portion of the loop then finish it at the appropriate place up against the deep part of the pedicle, and completes the tie. As in vessel ligation with a passer, crossing the segments prior tying the first 1/2 hitch facilitates flat application, with the best visual performance for both the tier & the assistant.
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