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Surgeon’s Knot and Tying Suture

How do you tie a two handed tand surgeon's knot in surgery? In today’s video, we’re breaking down one of the most foundational skills in surgery: the two-handed surgical knot. Another important part of this…it’s a surgeon’s knot! Whether you're a medical student learning the ropes, a surgical intern prepping for your first day in the OR, or a seasoned surgeon wanting to refresh your fundamentals, mastering the two-handed knot is absolutely essential. The two-handed tie is the cornerstone of secure wound closure, anastomoses, and ligation. It's especially useful when working with deep tissues or when instrument access is limited. In this video, I walk you through each step slowly, deliberately, and clearly, so you can follow along and practice the mechanics until it becomes second nature. The Technique – Step-by-Step ✔ Hand positioning ✔ Dominant vs non-dominant hand use ✔ Proper throws: forward and reverse ✔ Securing the knot with the right amount of tension ✔ Creating square knots every time (and avoiding granny knots) ✔ Common mistakes and how to fix them We’ll go over the first throw, the second throw, and the importance of alternating direction to make your knot hold securely. Why Hand Tying is Still Critical Even with instrument ties and robotic tools, the ability to hand tie is still expected in training and practice. From vascular surgery to trauma, from bowel anastomoses to pediatric cases, knowing how to tie a secure knot by hand can be the difference between a successful procedure and a complication. 🧠 Clinical Relevance: This skill isn’t just academic. Two-handed ties are used in: Ligation of vessels Bowel anastomoses Fascia closure Securing drains Urologic and gynecologic procedures Pediatric and minimally invasive surgery By practicing this skill, you’re preparing for real-world moments where precision matters — and where there’s no room for error. 🛠 Materials You Can Use to Practice: To follow along, grab any of these: A piece of string or suture A knot-tying board (or just a stable object to anchor your practice) A hook screw or wooden dowel Even your own fingers or a loop of tubing will work in a pinch Use this video as your daily drill until your hands move automatically and your knots are clean, flat, and tight. 🧬 Science Behind the Knot: Why does the two-handed tie work? Because it uses equal and opposite forces to cinch down on tissue with minimal slippage. When performed correctly, it creates a square knot, which distributes pressure evenly and resists untying under stress. This isn’t just about “tying a knot”—it’s about understanding tissue biomechanics, tension control, and precision handling, all of which are hallmarks of good surgical technique. WHO AM I? I'm Dr. Erik Pearson, FACS and I am a board certified pediatric surgeon living in Las Vegas. I make surgical education videos on all topics in general surgery, health, longevity as well as talks on lifestyle design as a surgeon, book reviews, and studying effectively. I also write a substack exploring the depths of life as a surgeon. EQUIPMENT Sigma 16mm F1.4 https://citizensurgeon.co/SigmaLens Sony FX30 Camera https://citizensurgeon.co/SonyFX30 MEDICAL ADVICE DISCLAIMER: All content in this video and description including infor­ma­tion, opinions, con­tent, ref­er­ences, and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing, or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and its author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or its description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­mu­nity in all mat­ters relat­ing to your health. Affiliate Links - There are a few links in the description that may lead to a kickback to me to help support the channel. #SurgeryIntern #GeneralSurgery #MedicalEducation #ResidencyLife #SurgicalResidency #MedStudentLife #FutureSurgeon #SurgicalBooks #ResidencyPrep #InternYear #ScrubLife #SurgeryTips #MedSchoolToResidency #SurgicalTraining #CitizenSurgeon #Surgicalknots #suturing