How to use a ligating reel?

[CBG23]

Every so often (q8-12 months) I get handed a vicryl ligating reel and I always fumble around with it. Can anyone explain or point me to a video of how to correctly use one of these things? A google/ youtube search left me with nothing...

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[doc05]

Really? Why is this so hard to figure out?

 

[Winged Scapula]

You release the end of the suture from the reel, pull it out, hold the reel in the palm of your non dominant hand, wrap the suture around whatever you wish to ligate and tie just like you would with any other suture.

 

[CBG23]

Really? Why is this so hard to figure out?

This was an incredibly helpful post. Thank you!

Addendum: you seem to be playing the role of the grumpy old surgeon on these boards based on your prior posts. Good for you,

 

[CBG23]

You release the end of the suture from the reel, pull it out, hold the reel in the palm of your non dominant hand, wrap the suture around whatever you wish to ligate and tie just like you would with any other suture.

Thanks for the reply. How do you cross the ends before tying without releasing the reel itself?

 

[LucidSplash]

Thanks for the reply. How do you cross the ends before tying without releasing the reel itself?

One-handed tie.

 

[CBG23]

One-handed tie.

In order to do a one-handed tie, you would use your dominant hand and NOT cross the suture prior to throwing down the knot though - in order to keep the reel in your non-dominant hand. Is that correct?

 

[Dr.LeoSpaceman]

I'm a righty. I tie one-handed with my left. Imagine the reel is any other "non-free" end (i.e. tonsil, needle w/ needle driver, etc.).

- Reel in right hand.
- Pass around clamp from right to left hand while holding free end with right.
- Pull out requisite amount of suture while passing, then exchange hands.
- The previous two steps, when done right, appear fluid. The reel should now be in right with free end in left and strands crossed to allow one-handed tie.

This is actually different than how I use free ties, as I don't pass the tonsil around the clamp.

And not to put too fine a point on it, but by you saying that this happens every 8-12 months you must be further along in training. At this point, you should honestly be able to bring home a reel and figure out how this "works". I try to teach my interns that the biggest mistake people make is to learn how to do things like tying (which then extends to other more advanced technical skills) one way, and not bother understanding why it's done that way. That works for medical students and interns, but the reality is that you often get into situations where that way might not work. Understanding the why lets you adapt to the situation. Sticking with tying, understanding how the knot is formed, and what makes a square knot allows you to tie with either hand and start with either one of the throws depending on how it's setup. But approaching it as "I must tie with this hand, with the strands in this configuration" is unnecessarily limiting.

 

[CBG23]

I'm a righty. I tie one-handed with my left. Imagine the reel is any other "non-free" end (i.e. tonsil, needle w/ needle driver, etc.).

- Reel in right hand.
- Pass around clamp from right to left hand while holding free end with right.
- Pull out requisite amount of suture while passing, then exchange hands.
- The previous two steps, when done right, appear fluid. The reel should now be in right with free end in left and strands crossed to allow one-handed tie.

This is actually different than how I use free ties, as I don't pass the tonsil around the clamp.

And not to put too fine a point on it, but by you saying that this happens every 8-12 months you must be further along in training. At this point, you should honestly be able to bring home a reel and figure out how this "works". I try to teach my interns that the biggest mistake people make is to learn how to do things like tying (which then extends to other more advanced technical skills) one way, and not bother understanding why it's done that way. That works for medical students and interns, but the reality is that you often get into situations where that way might not work. Understanding the why lets you adapt to the situation. Sticking with tying, understanding how the knot is formed, and what makes a square knot allows you to tie with either hand and start with either one of the throws depending on how it's setup. But approaching it as "I must tie with this hand, with the strands in this configuration" is unnecessarily limiting.

Thanks for your explanation and advice. Appreciate you taking the time to post

 

[Winged Scapula]

Thanks for the reply. How do you cross the ends before tying without releasing the reel itself?

You can also do it two handed by just letting out enough suture to cross the ends. continue to palm the reel and cut the suture away from the loose and the reel end; either way is fine.

 

[CBG23]

You can also do it two handed by just letting out enough suture to cross the ends. continue to palm the reel and cut the suture away from the loose and the reel end; either way is fine.

Cool. Thank you,

 

[DoctwoB]

Am I the only surgeon who saw this and thought "what the hell is a ligating reel?" Guess we don't use them where I train. Sounds like a spool of suture from what people are describing. Any benefit to using this over a pack of free ties?

 

[doc05]

Am I the only surgeon who saw this and thought "what the hell is a ligating reel?" Guess we don't use them where I train. Sounds like a spool of suture from what people are describing. Any benefit to using this over a pack of free ties?

Not at all.

 

[Smurfette]

Am I the only surgeon who saw this and thought "what the hell is a ligating reel?" Guess we don't use them where I train. Sounds like a spool of suture from what people are describing. Any benefit to using this over a pack of free ties?

You're not the only one. I'm kind of curious now, I'll have to ask if my hospitals even stock it.

 

[Jolie South]

Am I the only surgeon who saw this and thought "what the hell is a ligating reel?" Guess we don't use them where I train. Sounds like a spool of suture from what people are describing. Any benefit to using this over a pack of free ties?

You're not the only one. I'm kind of curious now, I'll have to ask if my hospitals even stock it.

I have only had one or two attendings at the VA that used these. I think they are more cumbersome than anything else. Isn't any faster than multiple free ties.

 

[Winged Scapula]

Huh...we had them during residency and I recall using them frequently, although I cannot recall with whom/what cases. But I totally agree that it wasn't all that great. Ours were reels of Vicryl, an Ethicon product IIRC.

 

[Winged Scapula]

 

[VincentAdultman]

Am I the only surgeon who saw this and thought "what the hell is a ligating reel?"

Nooooope

 

[vhawk]

Am I the only surgeon who saw this and thought "what the hell is a ligating reel?" Guess we don't use them where I train. Sounds like a spool of suture from what people are describing. Any benefit to using this over a pack of free ties?

It took me like 6 posts before I started to realize the thread wasnt a joke, like a snipe hunting thread.

 

[CTFellowMD]

Am I the only surgeon who saw this and thought "what the hell is a ligating reel?" Guess we don't use them where I train. Sounds like a spool of suture from what people are describing. Any benefit to using this over a pack of free ties?

Also had no idea what this was. **shrugs**

 

[Buzz Me]

Never used one of these before. But I think I've seen certain specialties (like ENT) use them.

 

[ACSurgeon]

We used them on trauma with a couple of old school surgeons. It's supposed to be faster when you are quickly clamping and tying bleeders.

 

[armybound]

My FIL (colorectal) uses chromic spools and stats to take mesenteric vessels. it's really weird but cheaper than opening a Ligasure (or whatever) like most of his colleagues.

he's clearly old school.