Caesarean section suturing skills

Caesarean section

Surgery.  It's a serious business with high stakes, taking place in a brightly lit operating theatre buzzing with the competence of the practitioners.  I'm writing at the end of my 8-week obstetrics and gynaecology attachment, and having worked through the basics of the knowledge in the books, lectures and clinics, I've now assisted the surgeons in the theatre - holding instruments, and for the first time, under the watchful eye of a surgeon (and with permission of the patient), stitching closed one of the tiny incisions.  Skills have come together from one of our teaching groups, SCRUBS where students teach each other suturing classes, and also from various bits of training from the experienced consultants.

The basics of any surgery are pretty formulaic (allowing you to automate the simple bits so you can deal with the unexpected).  So there are plenty of steps to learn.

Trying to describe the atmosphere to someone who's not been in an operating theatre is a challenge.  One way is to liken it to other activities from regular life:
- in some ways the operating theatre is like a formal meeting or dining occasion (there's a dress code, formal arrangements for who is placed where, you must not start until everyone is ready, there's etiquette about who talks to whom, no elbows/leaning on the table, and depending on status you may need to ask permission to get down from the table).
- in some ways the theatre is protocol driven like following a recipe (you have a set of instructions that need a bit of interpretation, there's cutting, there's searing with a diathermy probe, and there's plenty of cleaning up to do afterwards)
- and it's also a little like a home improvement project (if it ain't broke don't fix it, you get best results if you drill pilot holes before you screw in, nails need to be hammered in, the experienced practitioner lines things up by eye, and you have to know not to meddle too much - leave when it's good enough).

Steps of learning for any surgery

• Learn the anatomy of the body region
• Learn the steps in the procedure
• Learn the names of the instruments and sutures
• Train your muscles to learn the knots

Suturing and muscle memory needed for C-section skin 

• Hand-tying the basic surgeon's knot
• The running subcuticular suture
• The Aberdeen knot
• A summary video of the skin closure used by the docs I've seen at King's Mill 

My experience has been such that the team here are quite particular about skin suturing in caesarean section, and this placement I've not had a chance to deploy those skills learned on the skin pads.  Next surgical placements will be in the new year - ENT followed by orthopaedics - we'll see what the prospects are there.