Comm Eye Health South Asia Vol. 36 No. 120 2023 pp 15. Published online 25 January 2024.

Passing sutures

Jacqueline Newton

Staff Nurse: Flying Eye Hospital, Orbis International, Cape Town, South Africa.


Rebecca Jones

Ophthalmology Registrar: Cheltenham General Hospital, Cheltenham, UK.


Figure 1 The suture needle, suture, and needle holder. The centre or body of the needle is gripped by the tip of the needle holder. The surgeon is right-handed, so the sharp point of the needle faces to the left. (Photo: © REBECCA JONES CC BY-NC-SA 4.0)
Figure 1 The suture needle, suture, and needle holder. The centre or body of the needle is gripped by the tip of the needle holder. The surgeon is right-handed, so the sharp point of the needle faces to the left. (Photo: © REBECCA JONES CC BY-NC-SA 4.0)
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It is important to load sutures correctly before passing them to the surgeon.Pay attention to where and how you grip the needle, and be aware that a different position may be needed for left-handed surgeons.

Most sutures used in ophthalmic surgery are loaded onto curved needles, which should always be passed with the sharp tip and swage curving up, towards the ceiling.

Ask the surgeon ahead of time how they would like their needle to be loaded (or held) in the needle holder. Also, check whether they are right-handed or left-handed.

Forehand or backhand pass?

Most surgeons prefer to make forehand suture passes, working from the side of their dominant hand towards the centre of the operating field. For a right-handed surgeon, the needle tip must point to the left, and for a left-handed surgeon, it must point to the right.

Ask the surgeon to tell you if they want to make a backhand suture pass, i.e., working away from the centre of the operating field. A backhand pass for a right-handed surgeon would be loaded in the same orientation as a forehand pass for a left-handed surgeon, and vice versa.

Loading the needle holder

You will need:

• A needle holder (also known as a needle driver)

• The suture needle, with a suture attached to it

• A second instrument, such as tying forceps

Steps

1. Use the second instrument, such as tying forceps, to pick up the needle. Note: Do not touch the needle with your hands, even when wearing gloves. This will help to avoid injury.

2. Open the needle holder. Use the tip of the needle holder to grip the needle just to the rear of the centre of the needle; in other words, slightly closer to the swage than to the tip of the needle. Figures 1 and 2 show the correct position when loading a suture needle for a right-handed surgeon making a forehand pass; Figure 3 is the position for a left-handed surgeon.

3. Grasp the needle holder in the centre and pass to the surgeon.

Figure 2 Suture needle gripped correctly for a forehand pass by right-handed surgeon. (Photo: Jacqueline Newton CC BY-NC-SA 4.0)
Figure 2 Suture needle gripped correctly for a forehand pass by right-handed surgeon. (Photo: Jacqueline Newton CC BY-NC-SA 4.0)
Figure 3 Suture needle gripped correctly for a forehand pass by left-handed surgeon. (Photo:  Jacqueline Newton CC BY-NC-SA 4.0)
Figure 3 Suture needle gripped correctly for a forehand pass by left-handed surgeon. (Photo:  Jacqueline Newton CC BY-NC-SA 4.0)

Using a curved needle holder

Curved needle holders have a tip that is curved (or bent) to one side; this allows the surgeon more room to manipulate the suturing needle, without the needle holder getting in the way. To grip a suturing needle using a curved needle holder, rotate the needle holder so that the tip bends, or curves, in the direction of the swage (see Figures 2 and 3).

This YouTube video has useful practical tips: bit.ly/CEHJ-suture