‘Cambridge twist’: overlooked detail when teaching continuous sutures

Abstract

When a continuous suture is performed, torsional tension builds up in the thread that can lead to curling and false knots, requiring deliberate corrective movements from the assistant or surgeon. The systematic 360° rotation of the needle holder each time a stitch is passed avoids this problem. The authors’ assumption was that this technical point is rarely demonstrated to trainees, and that even some experienced surgeons are unaware of it. This technical note describes the movement of the needle holder (called ‘Cambridge twist’ as a tribute to the surgical rotation where it was probably learnt) and reports a survey showing that it is less used and known than could be presumed from its simplicity. In addition, a review of the most accessible suturing tutorials on the internet showed that none mentioned this detail. Video 1 demonstrates the technique and its rationale.