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Scissors 07 How to cut with scissors

This subsection has text and images from an interactive multimedia training program on basic surgical skills called PrimeSkills in Surgery. You can use this subsection on its own or follow the whole program (further details at the end of this subsection).



Holding the scissors

Bracing

Cutting





Holding the scissors



You should learn to hold the scissors in either hand in an identical fashion. For ease, start with your dominant hand.



Place your thumb in the ring of the upper handle.

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Use just the terminal phalanx.



The bulb of the terminal phalanx is plenty strong enough for a maximum squeeze.



If you put more of your thumb through the ring, you will limit the opening of the scissors.



Place your right ring finger through the lower ring.



Put only the terminal phalanx through the ring



The squeezing pressure falls on the terminal phalanx.



If you put more of the ring finger through the ring, you will likewise reduce the opening of the scissors.



Place your middle and index fingers around the lower edge of the lower half of the scissors.

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For better stability, place the index finger on the joint of the scissors.



This may only be relevant for very delicate stitch cutting (or long handled needle holders).

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Use a two handed grip where possible.



The joint of the scissors rests on the upper surface of the opposite index finger for even more stability.



Use the opposite index finger as a fulcrum.

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Alternative grips



Open hand method



Place the rings of the handles in the palm of your hand.

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Hold one ring of the handles with the thumb and index finger.



Place your ring finger in the other ring.



Close the scissors by squeezing the index and ring fingers together.



The grip is as unstable as the two digit grip above, but it is a simple, if wobbly, way of cutting with your left hand.



Dagger method



Hold the scissors like a dagger, with the thumb in one ring and the middle finger in the other.

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It is inherently unstable, but may be useful when operating at the bottom of a deep cavity such as the thorax with vertical



instruments. It avoids tiring elevation of the elbow with a standard grip.



It is the type of complex grip a beginner may use before being aware of the simple standard grip.



Bracing

The expert uses a large number of subtle bracing methods to remove the last tendency for the ends of the scissors to shake or wobble.



Do not touch the patient's skin - it is probably unsterile.



Use some or all of the following methods of bracing. With each method, the scissors make contact with firm structures:



A finger of either hand touching the patient.

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The little finger can touch the opposite hand as well.

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One hand touching the other.

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A wrist of either hand touching the patient.



Either elbow touching the patient.

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Either elbow tucked into the waist.

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Your pelvis leaning on the patient or the operating table.





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Check the operating table brake is locked before you lean against the table.



Cutting



The aim is to cut the stitch. This may be up to six thicknesses of suture, for instance at the end of an abdominal wound closure with double nylon.



Open just the most distal 8mm. of the jaws.

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If you open less than 8mm:





The smaller opening of the jaws make touching the stitch more difficult.





The tips of the jaws may not cut the stitch.





Less powerful closing leverage.





Less powerful sideways compression.





Prone to damage and misalignment.



If you open the jaws wider than 8mm:





Risk of cutting other structures as well as the stitch.



Push the opened jaws on to the stitch:

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With the jaws perpendicular to the stitch.



With the thumb handles uppermost for maximum visibility.



Close the handles smoothly and steadily until the stitch cuts.



Do not jab at the stitch.



Learn to make an automatic lateral movement of the thumb handle to the left to increase the shear.



Make an automatic 200gm. pressure into the stitch.



This will counteract the tendency of the stitch to slide along the blades, towards the tips of the scissors.



If the stitch(es) do not cut, i.e. jams in the jaws:



Try again with increased lateral movement of the handles.



The thumb handle to the left and the ring finger handle to the right.



Increase the pressure on the stitch.



Check the blades are not held obliquely so as to provoke a crush or a jamming of the suture.



Check the blades are perpendicular to the stitch to minimise the cross section of suture to be cut.





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If the stitch(es) still do not cut:



Try again with more concentration.



Change the scissors to your right hand.



Give the scissors to a more experienced assistant.



Change the scissors



If you cut the stitch with the scissors on a slant you are half way to jamming the stitch.



Diagonal cutting of the suture will require more effort and cutting than a perpendicular cut, increasing the chance of failed



cutting.



Diagonal cutting may obscure the site of cutting to the assistant and the surgeon. ie the important length of suture between the



knot and the scissors.

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An alternative:

Touch the suture at some point and slide the blades down to the required cutting point.



The actual touching of the suture by the scissors gives an instant feeling of confidence to the scissor operator.



The stitch should be cut:



At the first attempt.



Cleanly.



Quickly.



Without delay.



Smoothly.



Without hesitating.



Without shaking.



Without fumbling.



You need to be able to cut:



At any point of the compass.



Using which ever hand is the nearest.



At any depth in the wound.



Ambidextrous use of scissors is absolutely essential for the surgical assistant.







