Palming the needle driver

[drtx]

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Alright,

I'm getting a little confused. In the same week I was told "you have to start palming the instrument..." Then, another surgeon I was operating with said "Put your fingers in the rings that is what they are there for."

WTF!!! I am faster palming but is there any real dogma on how to hold the needle driver?

 

[Winged Scapula]

Alright,

I'm getting a little confused. In the same week I was told "you have to start palming the instrument..." Then, another surgeon I was operating with said "Put your fingers in the rings that is what they are there for."

WTF!!! I am faster palming but is there any real dogma on how to hold the needle driver?

Eh, it depends on whom you are working with (as you see). I had the same experience as a resident, with one attending preferring one way and another something different. There is no "right way".

I palmed the driver a lot as a medical student but it was easier for me with the fine drivers I used on my plastics rotations. With the larger drivers in gen surg, I could never get the thenar strength to open and close it that way (plus you may use Castros for vascular). Either change it as the situation calls for or pick whatever is most comfortable with you and stick with that.

 

[Celiac Plexus]

What the op describes is pretty typical for interns and junior residents to go through. It's not just palming the driver, but it's other things like tieing, or whether to close fascia with pds or prolene, or whether to use staples or suture for skin, or whether to use the bookwalter or the omnitract, or the stephens retractor...the list goes on... Eventually you will work with all of your staff enough to know what he/she prefers. Until then, you sort of have to learn by trial and error. You have to operate the way your attending wants you to operate so you have to get good at doing operative maneuvers many different ways.

When you are a senior resident, for the most part, attendings will stop this type of criticism. Just refrain from the urge to say "the plastics guys all palm the driver"... lmfao.

And as to your original question... no there is no central needle driver dogma. It's whatever you feel comfortable with. I always palm the driver, and haven't noticed any "thenar" issues.

 

[MOHS_01]

Can't speak as to when working in the cavity, but palm it on the skin -- more ergonomic, better control, quicker. If you have trouble opening/closing, just find a pair (or buy a cheap pair) and practice when waiting for the next page... you'll be proficient in no time.

 

[njbmd]

Alright,

I'm getting a little confused. In the same week I was told "you have to start palming the instrument..." Then, another surgeon I was operating with said "Put your fingers in the rings that is what they are there for."

WTF!!! I am faster palming but is there any real dogma on how to hold the needle driver?

Adapt my young resident friend! It's not a matter of "dogma" but a matter of adapting to the wide variety of styles that you will be exposed to in residency. With practice and experience, you will develop what works for you. I can tell you that I was criticized right and left for all sorts of things during my junior resident years. I practiced and adapted to the style of the attending that I was operating with. In the end, I developed enough experience to do what worked safely and comfortably for the size of my hands and the needs of my patients under a variety of circumstances.

When you are trying to learn and hone new skills, it's confusing (and stressful) but practice and adapt. I kept a cheap pair of hemostats in my pocket to practice palming when I was sitting around. I learned to switch styles at the drop of a hat without even thinking about it. The good thing is that there is no "dogma" and that as the wise ones above have said, as you rise up in experience and years, your style will be under less question as long as it's safe and effective.

 

[drtx]

It is comforting that at least this kind of thing is just another typical part of residency and I guess you gotta just learn to go with the flow. I just wanted to know if there was a real answer to whether this really made a difference...Thanks for answering my question.

 

[Sarcophageal]

Granted I am only an M4, if you will pay attention during a surgery or before you will notice a lot of Dr. SO and SO does not like to use the Bovie on cutting, Addisons on the skin, more than three ties on silk, continuous rate on PCA..... It really just goes to show you that people have preferences, but only some of them REALLY matter.

And if we don't palm at our school we get made fun of.......

 

[Winged Scapula]

Granted I am only an M4, if you will pay attention during a surgery or before you will notice a lot of Dr. SO and SO does not like to use the Bovie on cutting, Addisons on the skin, more than three ties on silk, continuous rate on PCA..... It really just goes to show you that people have preferences, but only some of them REALLY matter.

And if we don't palm at our school we get made fun of.......

FYI...not that its really important, but lest you get made fun of...its Adson's (not Addisons...which is an important disease with some skin manifestations but not "used on the skin"). 😉

You are right...a great portion of surgical training was figuring out which attending liked things done which way and remembering so you can inform your juniors.

 

[tussy]

It never stops. I'm an attending and yesterday I was post call after a rough night of call and one of my senior colleagues asked me for help on a tough cancer case. It was the end of the case and i was closing part of the wound and he said "gee, you never did learn to palm that needle driver did you" You can never win.