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Today, we're going to learn how to do an instrument tie for this. You'll need your needle driver, your pickups, suture, scissors, and really any type of future will work fine. You can use this skill to tie and secure any not in the operating room, but you'll often use it for skin closures or when you're securing drains or tubes in the operating room. So we'll start by picking up our needle driver and loading our needle into our needle driver. Now, we'll want to make sure that we set ourselves up for success and this means loading our needle with the needle tip pointed straight up towards the ceiling and the needle loaded into the needle driver at a slight 45 degree angle. We'll go ahead and grab our pickups. And for this, we'll start by throwing a simple interrupted stitch. We'll start by picking up one of the edges of our incision and passing are needle through. We'll go ahead and pick up our needle and reload it on the patient and we'll pick up on the opposite edge of the incision and once again, pass our needle through. Now, once we've completely thrown our stitch we're going to want to pull our future all the way through until we have about a 123 centimeter tail. You definitely don't want your tail too long or too short. It just makes the instrument tie that much more difficult. Now to do our instrument. I will start by putting our needle driver in between the tail end of our future and our needled end of our suture almost. So it's completely in line with the incision. We'll go ahead and pick up the needled end of the future and we'll wrap it once twice around the needle driver going towards the tail of the future. We'll go ahead and pick up the very tip of the tail with our needle driver and we'll pass the needles end of the suture over the tip of our needle driver before crossing our hands to secure or not. Now, by crossing her hands, you'll notice that the tail end ends on the opposite side of the incision from where it started. And the needled end of the future also ends up on the opposite side of the incision from where it started. You want to do this to make sure that you throw a nice square. Not now, for most closures, you're going to want to throw 3 to 4 knots. So we'll repeat this process by once again, placing our needle driver in between the needled end and tail and over suture, we'll wrap the needled end of the future. Once around the needle driver towards the tail, we'll pick up the edge of the tail. Pull the needle the end of the future over the top of her needle driver. And again, we'll cross our hands. So that way, the tail end ends on the opposite side from where it started and the needle end ends up on the opposite side from where it started of our incision. We'll go ahead and repeat this process one more time. Once again, placing our needle driver in between our tail and our needled end of our suture, wrapping the needled end of our suture around our needle driver once towards the tail, grabbing the tip of our tail, pulling our future overtop the needle driver and crossing our hands. So that way the tail and the needled end and on opposite sides of the incision from where they started, that gives us about three knots. So at this point, we're okay to go ahead and cut the tales of our suture. For most closures, you can get away with about a one centimeter tale but different materials and different types of closures require different lengths. So if you're not sure, just go ahead and ask your resident and once you cut both ends of the future, you've completed your instrument tie.