Tying a pedicle so it can be cut between ligatures is done by using the ties on passers, & can be done by doing the following steps.
Step 1. The doctors places an angled clamp under-neath the pedicle and opens the jaws after it shows on the other side of the tissue. The nurse then places a tie on a passer, then with your free hand hold taut between and the clamp in the other one, deep to the angled clamp's jaws. The surgeon grabs the taut portion of ligature with the angled clamp. When grasping a taut segment, as opposed to a free end dangling under the passer, these operators do control the ligature.
Step 2. The surgeon pauses until he sees that the ligature has been let go, prior ro pulling through. clamping and pulling the ligature all in a solo motion prior to it being released results in a torn pedicle that proves both disgraceful to the operators and could be hazardous to the patient.
Step 3. The doctor takes the free ends in one hand, leaving the assistant with both hands free to go pass the second ligature and right into the angled clamp's teeth.
Step 4. The assistant retains the 2nd ligature and ties his side 1st. Slight retraction in the appropriate direction of the single ligature will help maintain reserve between the two while the other is fixed. Countertraction during tying of one ligature can sometimes be aided by grasping the opposite ligature deep in the wound with a surgical instrument and correctively guiding its tension.
To assure safe distance between the 2 ties, the knot tier forms the 1st half hitch, then before tying it down, places his 2 index fingers inside the loop. Take the deep portion of the loop then finish it at the appropriate place up against the deep part of the pedicle, and finishes the tie. As in vessel ligation with a passer, crossing the segments before tying the 1st 1/2 hitch facilitates flat application, with greatest visibility for both assistant & tier.
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