1. Instrument Tie - Step 1 The short end is away from the surgeon, the left hand holds the long strand, and the needle holder is pointing to the left.

2. Instrument Tie - Step 2 A loop is created around the needle holder by bringing the long strand away from the surgeon.

3. Instrument Tie - Step 3 The long strand is looped around the needle holder.

4. Instrument Tie - Step 4 The needle holder, which now protrudes through the loop, grasps the short strand, and it will be pulled back through the loop toward the surgeon.

5. Instrument Tie - Step 5 As the short strand is pulled toward the surgeon, the long strand is pushed away.

6. Instrument Tie - Step 6 The throw is tightened by pulling with equal tension in opposite directions.

7. Instrument Tie - Step7 Note that the short end is now toward the surgeon, and the needle holder again is pointing to the left. The left hand initiates creation of the 2nd loop by bringing the long strand toward the surgeon.

8. Instrument Tie - Step 8...and the tip of needle holder will now be rotated toward the surgeon to grasp the short end. The left hand brings the long strand toward the surgeon,

9. Instrument Tie - Step 9 The tip of needle holder has now been rotated toward the surgeon, and grasps the short end, which will be pulled back through the loop.

10. Instrument Tie - Step 10 … and the left hand pulls the long strand toward the surgeon The needle holder has pulled the short end back through the loop away from the surgeon,

11. Instrument Tie - Step11 The second throw is tightened by pulling with equal tension in opposite directions.

12. Instrument Tie - Step12 A 3rd throw is initiated in the same fashion as the 1st throw. Note that once again the short end is away from the surgeon, the left hand holds the long strand, and the needle holder is pointing to the left.

13. Instrument Tie - Step13 A loop is created around the needle holder by bringing the long strand away from the surgeon and around the needle holder.

14. Instrument Tie - Step14 The needle holder, which now protrudes through the loop, grasps the short strand, and it will be pulled back through the loop toward the surgeon.

15. Instrument Tie - Step15 The short strand is pulled back through the loop toward the surgeon.

16. Instrument Tie - Step16 And the 3rd throw is tightened by pulling with equal tension in opposite directions.