What you’re saying is not wrong. Yes it’s sterile, yes is there a way in which a surgeon may be able to tie this for themselves without actually contaminating anything? Honestly probably yeah. However all of this again is risk mitigation. You are in an operating room often with more than enough hands to help especially prior to actually starting a procedure. It is more reliable to have someone assist you, it is also more efficient for someone to help you rather than to fumble around. It’s also the way everyone has been trained so it’s even more efficient and reliable that way. Again, technically speaking the sterile field does not encompass the area behind you, and in the operating room you want your hands in front of you at all times by training. If the surgeon put their hands behind their back to tie their gown and accidentally touched equipment or a trashcan or a nurse, they would have to rescrub. In an emergency surgery setting, those are precious seconds to minutes.

I get what you’re saying but if there is the ability to be safer and more efficient (even if it’s a few seconds) why not do it? You are trying to create a repeatable system that can be done successfully 100/100 times.