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Influence of training on reliability of surgical knots
T E Ind1, J C Shelton, J H Shepherd
1The Gynaecological Cancer Centre, St Bartholomew's Hospital, London, UK.
Objectives:
To determine whether trainees in obstetrics and gynaecology tie adequate surgical knots and to assess whether formal training improves knot tying skills.
Design:
A comparative study assessing surgical knots before and after tuition.
Population:
Fourteen trainees in a single obstetrics and gynaecology department.
Setting:
A basic surgical skills workshop based in a London teaching hospital.
Methods:
Trainees tied surgical knots around a 120mm jig using 2/0 glycan polymer. Each trainee tied 11 knots before and after a two and a half hour teaching session. Knots were tested using a mechanical testing machine.
Outcome Measures:
Knot strength (N); proportion of knots that were 'secure' (defined as those that eventually failed on the testing device by breakage rather than slippage); proportion of knots that were 'dangerous' (defined as those with a tensile strength of < 5 N).
Results:
After tuition, the median knot strength of the whole group was 5.7 N stronger than before instruction (95% CI 4.6-12.3 N). Prior to tuition 13.5% (20/148) knots tied had a tensile strength of < 5 N. This was compared with 3.4% (5/148) after tuition (OR = 0.2, 95% CI 0.1-0.6). Before instruction 55.4% (82/148) of the knots were secure compared with 66.9% (99/148) after tuition (OR = 1.6, 95% CI 1.0-2.7).
Conclusion:
Knot tying workshops can improve the ability of trainees in obstetrics and gynaecology to tie reef knots.