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Task 6: Continuous Suturing At Depth: Push-Push-Pull | Advanced Training Open Surgical Skills Lab
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class="breadcrumbs__item"> Task 6: Continuous Suturing At Depth: Push-Push-Pull </li> </ol> </div> </nav> </div> </div> <div class="main l-content no-sidebar"> <div class="page-content-outer-wrap"> <div class="region region-title"> <div id="block-dos-page-title" class="block block-core block-page-title-block"> <h1 class="page-title"><span class="field field--name-title field--type-string field--label-hidden">Task 6: Continuous Suturing At Depth: Push-Push-Pull</span> </h1> </div> </div> <div class="page-content-inner-wrap"> <div class="page-content"> <div class="region region-content"> <div id="block-dos-content" class="block block-system block-system-main-block"> <article data-history-node-id="132006" class="node node--type-page node--view-mode-full"> <div class="node__content"> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="page-css-override"><h2>Instructional Video</h2> <article class="media media--type-kan-remote-video media--view-mode-inline-image" aria-label="Image about "> <div class="field field--name-kan-field-media-oembed-video field--type-string field--label-hidden field__item iframe-container"><iframe src="https://advancedopensurgicalskills.ucsf.edu/media/oembed?url=https%3A//www.youtube.com/watch%3Fv%3D4WpXs8rfHQQ&max_width=1280&max_height=720&hash=8D08_qPVpJviUZyncCGRv1vWVI85eRu5KEXcDzywjm4" width="1280" height="720" class="media-oembed-content" loading="eager" title="At Depth Push Push Pull Suturing Technique (Task 6) - Instructional Video"></iframe> </div> </article> <p>(Link: <a href="https://www.youtube.com/watch?v=4WpXs8rfHQQ">https://www.youtube.com/watch?v=4WpXs8rfHQQ</a>)</p><h2>Task Details <br>Task 6: Continuous Suturing At Depth: Push-Push-Pull</h2><h3>Summary</h3><p>This task requires 10 continuous sutures at depth using push-push-pull reloading technique.</p><h3>Equipment</h3><p>One fine needle holder, one fine forceps, one 5-0 or 6-0 Prolene suture on a C1 cut to 15cm.</p><h3>Task set-up</h3><p>Position fabric at the base of the model (lowest platform level) as follows:</p> <figure class="media media--type-image media--view-mode-inline-image"> <div class="field field--name-field-media-image field--type-image field--label-hidden field__item"> <img loading="eager" srcset="/sites/default/files/styles/max_325x325/public/umbraco/media/13796694/task5-6-image1.png.webp?itok=sW5xNKsp 325w, /sites/default/files/styles/max_875x875/public/umbraco/media/13796694/task5-6-image1.png.webp?itok=1H3whr6g 546w" sizes="(min-width: 76rem) 33rem, calc(100vw - 2.5rem)" width="546" height="364" src="/sites/default/files/styles/max_325x325/public/umbraco/media/13796694/task5-6-image1.png.webp?itok=sW5xNKsp" alt="task5-6-image1" title="task5-6-image1"> </div> </figure> <h3>Task steps</h3><ol><li>Load needle into fine needle holder.<br>Complete 10 continuous sutures at depth using push-push-pull reloading technique.</li></ol><h3>Task rules</h3><p>Take single bites, entering and exiting at blue dots on either side of the slit. Use forceps to stabilize the tissue. Reload needle while still in tissue then atraumatically remove. Lock the needle driver after the needle is completely removed from tissue, then rotate the needle holder in preparation for the next bite.</p><h3>Tips & tricks</h3><ul><li>Load your needle at a 100-150 degree angle.</li><li>Unlock needle holder before entering tissue; do not lock until needle is fully removed from tissue.</li><li>Use forceps to stabilize tissue at needle entry and exit.</li><li>Do not handle the needle tip with forceps (this will cause damage and blunting).</li><li>Follow the curve of the needle when removing it from tissue, do not torque.</li><li>For push-push-pull, introduce the needle into the tissue far enough to expose at least 50% of the needle, so that the final loading of the needle with the needle holder will be in the appropriate segment of the needle.</li></ul><h3>Cutoff time</h3><p>Maximum time for task completion is 260 seconds. During formal assessment, time will start when the needle makes contact with the tissue for the 1st time and end when the needle is removed from tissue for the last (10th) time. If the task is not completed within the allotted time, you will be asked to stop.</p><h3>Scoring</h3><p>A score will be assigned for each micro-skill. Score assignments are based on the following:</p><table class="table-line-height-variance" style="border-collapse:collapse;border-spacing:0px;box-sizing:inherit;margin:0px;max-width:100%;padding:0px;table-layout:fixed;text-align:justify;width:847.508px;" border="0"><tbody style="border-width:0px;box-sizing:inherit;margin:0px;padding:0px;"><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Score:</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">1</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">2</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">3</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">4</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">5</strong></p></td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Description:</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Unable to complete task</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Completed task w/ major errors</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Completed task w/ minor errors</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Proficient, no errors, some awkward moves</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:2.16pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Expert, no errors, smooth and efficient</p></td></tr></tbody></table><p><br> </p><table class="botom-table-css" style="width:846px;" border="0"><tbody style="border-width:0px;box-sizing:inherit;margin:0px;padding:0px;"><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p class="text-align-center" style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Micro-Skill</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p class="text-align-center" style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Score (1-5)</strong></p></td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr">1. Loading the needle with correct angle</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"> </td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr">2. Releasing the needle in atraumatic fashion</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"> </td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr">3. Pushing the needle through the tissue in atraumatic fashion</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"> </td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr">4. Reloading the needle in the correct orientation for the next stitch</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"> </td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr">5. Following the curve of the needle</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"> </td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px;padding:0px;vertical-align:baseline;" dir="ltr">6. Overall Rating</p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"> </td></tr><tr style="border-width:0px;box-sizing:inherit;height:0pt;margin:0px;padding:5px 0px;"><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"><p style="border-width:0px;box-sizing:inherit;font-size:inherit;line-height:1.2;margin:0pt 0px 0pt 4.5pt;padding:2px;vertical-align:baseline;" dir="ltr"><strong style="border-width:0px;box-sizing:inherit;font-size:inherit;margin:0px;padding:0px;vertical-align:baseline;">Total (Sum of Scores for All Micro-Skill) [Max = 30]</strong></p></td><td style="border:1pt solid rgb(0, 0, 0);box-sizing:inherit;margin:0px;overflow-wrap:break-word;overflow:hidden;padding:0.72pt;text-align:left;vertical-align:top;"> </td></tr></tbody></table><h3><br>Scoring Formula</h3><p>see <a href="/node/131961" data-entity-type="node" data-entity-uuid="f7537d1c-6031-469d-a007-ffdd386eb652" data-entity-substitution="canonical">Task & Scoring Overview</a> or score calculator (access via <a href="https://docs.google.com/spreadsheets/d/1wD4eu8nPwqFmdJvfgVBCsUC67sW4maCNYdWViZSwAu8/edit#gid=0">Google doc</a> or <a href="/sites/default/files/umbraco/media/13854455/atoss_scoring_calculator.xlsx">download excel file</a>)</p><h3>Expert Score</h3><p>50</p><h2>Example Video</h2> <article class="media media--type-kan-remote-video media--view-mode-inline-image" aria-label="Image about "> <div class="field field--name-kan-field-media-oembed-video field--type-string field--label-hidden field__item iframe-container"><iframe src="https://advancedopensurgicalskills.ucsf.edu/media/oembed?url=https%3A//www.youtube.com/watch%3Fv%3DmlYoB8v5JEc&max_width=1280&max_height=720&hash=H72z7Uu2kafljC-QTUECE7pwTTdgk22yq9P6EkHT-gs" width="1280" height="720" class="media-oembed-content" loading="eager" title="At Depth Push Push Pull Suturing Technique (Task 6) - Example Video"></iframe> </div> </article> <p>(Link: <a href="https://www.youtube.com/watch?v=mlYoB8v5JEc">https://www.youtube.com/watch?v=mlYoB8v5JEc</a>)</p></div></div> <div><style> .page-css-override table td {padding-left:7px !important;} .page-css-override table.table-line-height-variance td p {line-height:1.8rem !important;} table.botom-table-css tr td p {padding:3px 0 !important;} </style></div> </div> </article> </div> <div id="block-dos-allsitescss" class="block block-block-content block-block-contenta4909052-afa3-4391-af88-9e84f68a8e60"> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><style> .zoom-1-025:hover { transform: scale(1.025); } .zoom-1-05:hover { transform: scale(1.05); } .zoom-1-1:hover { transform: scale(1.1); } .zoom-1-2:hover { transform: scale(1.2); } .zoom-1-5:hover { transform: scale(1.5); } .zoom, .zoom-1-05, .zoom-1-1, .zoom-1-5, .zoom-1-2, .zoom-1-025 {transition: 1s; z-index:10;} @media (max-width: 54em) { .h1, h1, h1 span.field--name-title { font-size: 2.6rem; letter-spacing: -0.1125rem; } } </style></div> </div> </div> </div> </div> </div> </div> </main> <footer class="footer"> <div class="footer__container"> <div class="footer__wrap"> <div class="footer__inner"> <div class="footer__first"> <figure class="footer__logo"> <a class="footer__logo-link" href="/" title="Home Advanced Training Open Surgical Skills Lab"> <picture class="footer__logo-image"> <img class="footer-logo__img" src="/themes/custom/dos/dist/icon/svg/footer-logo.svg" alt="UCSF Footer Logo" width="160" height="79"> </picture> </a> </figure> </div> <div class="footer__second"> <div class="footer__social"> <span>Follow Us:</span> <ul region="footer" class="menu-social"> <li class="menu-item menu-item--twitter"> <a href="https://twitter.com/UCSFSurgery" target="_blank" class="twitter">Twitter</a> </li> <li class="menu-item menu-item--instagram"> <a href="https://www.instagram.com/ucsf_surgery/?hl=en" target="_blank" class="instagram">Instagram</a> </li> <li class="menu-item menu-item--linkedin"> <a href="https://www.linkedin.com/in/ucsf-department-of-surgery-242831257/" target="_blank" class="linkedin">LinkedIn</a> </li> <li class="menu-item menu-item--youtube"> <a href="https://www.youtube.com/channel/UCICCJchdaNcdDkzSJUktktw" target="_blank" class="youtube" title="YouTube - 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