Instrument ties are most useful in open surgery when multiple fast superficial ties of sutures are required. They are not appropriate for tying important structures or when fine control is important. Instrument ties are the rule in laparoscopic and microsurgery and these ties differ from the open instrument tie.
The same principles used in hand ties apply to instrument ties: There is a short free working end, and a long end with the needle attached; the throws are oreinted toward and away from the operator; the strands reverse sides with each throw; the loops are kept loose and open as they are closed. The only difference is that it is always the left index finger that snugs each throw.
Practice initially leaving open loops between throws to visualize and establish the pattern of moves.
The long end (yellow) usually starts toward the operator since it is proper technique to suture toward oneself. The long end is grasped with the middle, ring and little finger of the left hand a safe distance away from the needle and at the distance that will allow the index finger to just reach the knot for tightening. The left thumb and index also grasp the long strand for fine control. The needle driver is placed over the site of the knot perpendicular to the loop that will be formed toward and away from the operator. The long end is wrapped over and around the needle driver, returning temporarily to the near side from which it started. For a surgeon's (friction) throw the strand is wrapped twice.
Link to this frame from your Personal Thumbnails page?