Wetting Surgical Gloves for Knot Tying
Some surgeons moisten gloved fingertips with sterile saline to adjust suture handling during hand tying. Treat this as a handling preference, not an established method of preventing glove perforation, anastomotic leakage or surgical-site infection. The studies below primarily test suture/knot materials under laboratory conditions; they do not establish those clinical benefits from wetting gloves.
See Sutures for material selection and Surgical Gloving for barrier protection.
Wet Suture Is Not the Same Intervention as Wet Gloves
| Study | What was actually tested | Interpretation |
|---|---|---|
| Pietschmann 2011 | Arthroscopic knots in five suture materials under dry versus saline-soaked test conditions; fewer slips were reported in the wet condition.[1] | Material- and test-specific bench evidence, not a clinical trial of moistening gloves. |
| Savage 2023 | Four No. 2 suture materials and four arthroscopic knots, tested dry or after 24-hour saline soaking, under a monotonic tensile test.[2] | Wet conditions generally reduced failure strength for Ethibond, Orthocord and FiberWire, while ForceFiber behaved differently. Knot, material and environment interacted; moisture is not uniformly beneficial or even neutral. |
| Coleridge 2017 | Veterinary bench testing of continuous-pattern ending knots in polyglactin 910 or PDS, exposed to electrolyte solution, serum or fat.[3] | Effects depend on the tested combination. This does not establish a GU knot-tying protocol. |
| Muffly 2012 | Saline versus petroleum exposure of sutures.[4] | Petroleum exposure impaired performance relative to saline. This does not show that blood, povidone-iodine or every other fluid behaves like petroleum. |
The reviewed evidence therefore does not support a universal instruction to wet every monofilament or high-strength braid before tying, or to soak sutures for better clinical outcomes.
What the Glove-Damage Studies Show
Enz and colleagues examined gloves used specifically for knot tying in 117 orthopedic operations. Damage occurred in gloves from approximately 25–37% of operations, depending on procedure. These are operation-level proportions from one setting and glove product, not the expected perforation rate for all GU surgeons. A separate simulation demonstrated bacterial passage through deliberately punctured gloves; it did not measure postoperative infection or show that saline wetting prevents passage.[5]
A small randomized knot-quality experiment reported lower knot-quality scores with double gloving. The experiment did not measure clinical anastomotic failure. Select barrier protection using the broader gloving evidence; changing an outer glove has not been shown to restore knot performance in this experiment.[6]
Practical Application
- If saline-moistened fingertips improve control, use a sterile source within the operative field and assess the actual knot's seating and tension. Do not add unvalidated lubricants or assume moisture improves security.
- Avoid wrapping tight suture loops around fingers or using excessive traction. A suspected glove breach requires a glove change; wetting cannot repair it. Follow the gloving protocol.
- Select the knot configuration and number of throws for the actual material, caliber and task. Laboratory findings do not justify one throw count or a three-to-five-twist starting throw for every GU suture. Loop security and final knot security are different properties.[7]
- For robotic intracorporeal tying, console gloves do not contact the suture. Focus on instrument handling, loop formation and tissue tension; wetting the surgeon's gloves before docking is not an evidence-based knot-security intervention.
References
1. Pietschmann MF, et al. Influence of testing conditions on primary stability of arthroscopic knot tying for rotator cuff repair: slippery when wet? Arthroscopy. 2011;27:1628–1636. doi:10.1016/j.arthro.2011.06.031.
2. Savage E, et al. Arthroscopic knots: suture and knot characterisation of modern polyblend suture materials. Heliyon. 2023;9:e19391. doi:10.1016/j.heliyon.2023.e19391.
3. Coleridge M, et al. Effect of fluid media on the mechanical properties of continuous pattern-ending surgeon's, square, and Aberdeen knots in vitro. Vet Surg. 2017;46:306–315. doi:10.1111/vsu.12627.
4. Muffly TM, et al. Effect of petroleum gauze packing on the mechanical properties of suture materials. J Surg Educ. 2012;69:37–40. doi:10.1016/j.jsurg.2011.06.012.
5. Enz A, et al. Knot tying in arthroplasty and arthroscopy causes lesions to surgical gloves: a potential risk of infection. Knee Surg Sports Traumatol Arthrosc. 2023;31:1824–1832. doi:10.1007/s00167-022-07136-7.
6. Battersby CL, et al. Double-gloving impairs the quality of surgical knot tying: a randomised controlled trial. World J Surg. 2016;40:2598–2602. doi:10.1007/s00268-016-3577-z.
7. Romeo A, et al. Effect of diameter and type of suture on knot and loop security. J Clin Med. 2023;12:6418. doi:10.3390/jcm12196418.