A Simple, Innovative Surgical-Instruction Tool

It is established that, in any educational environment, the instructor uses many devices to emphasize and stress important elements in the learning process. These elements include lasers, cursors, and pointers. All have their advantages and limitations.

In the field of surgery and its subspecialties, every procedure undertaken by the learner, in this case, the resident, is both a potential and actual learning process. Although the resident may prepare for the procedure by reading the textbook, attending didactic sessions, or viewing videos of surgical procedures, the actual procedure in the operating theater is different. The anatomy is not quite the same as it is in the textbook, exposure is more difficult, and landmarks are often not quite as pronounced. At this point, the experience and expertise of the teacher or staff physician is the bridge that makes the learning experience a true one.

Many projects in surgical instruction have been developed, but they deal with academic and classroom modules, as opposed to actual teaching demonstrations in the operating theater.

At the Texas Tech Health Sciences Center of the Permian Basin, a simplified and inexpensive device has been successfully used for the past 3 years: a 14-inch anodized knitting needle. It is made of lightweight aluminum, can be reautoclaved without risk of transmitting any infection, and is remarkably inexpensive. The length of the needle of 14 to 16 inches allows the instructor to point to structures or landmarks that may be difficult to emphasize by terms, such as “up a little higher” or “put the needle a little more lateral (or medial).” Although the use of the Yankauer suction tip or any other long instrument from the Mayo stand may be just as functional, their primary use is not for demonstrating technique. The versatility of the knitting needle for this type of instruction makes it valuable for virtually all forms of surgery, including abdominal, pelvic, or thoracic surgery. A practical attribute is that the length of the needle allows for specific directions without obscuring the operative field with the tutor’s hands.

The knitting needle can be used to help direct the spacing of sutures when closing the uterus at the time of cesarean section or closing the abdomen to complete the operation (figure 1). It can also be used to demonstrate the site of incision on the cervix at the time of vaginal hysterectomy (figure 2). Moreover, the knitting needle has the advantage of demonstrating pathology that has to be excised when working in the deep pelvis or vaginal vault without obscuring the area to be emphasized. The pointer can also be useful in general surgery procedures as well as in the field of radiology when radiologic films are viewed either on Power Point (Microsoft, Redmond, Washington) or on standard x-ray films.

The accompanying figures demonstrate some of the examples for the use of this simple, innovative measure or an innovative tool in actual surgical procedures.

Last, but not least, currently, when the cost of surgical instruments is considered, the inexpensive cost for a surgical instrument with this degree of clinical utility makes its use even more attractive.