Related Experiment Video
Updated: May 7, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Intracorporeal knot tying in a box trainer: how proficient is in vitro evaluation in laparoscopic experts?
A R H Twijnstra1, E Hiemstra1, E W van Zwet2
1Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
Objective:
To determine the applicability of motion analysis parameters of intracorporeal knot tying in box trainers in experts as predictors of surgical outcome.
Design:
Consecutive series of 1534 advanced laparoscopic hysterectomies (Canadian Task Force classification II-2).
Intervention:
Time, path length, and motion in depth of a standardized intracorporeal knot-tying task were compared with mean risk-adjusted primary clinical outcomes for each participant.
Results:
Although a large variety in proficient knot tying and surgical skills factors was observed; after correction for patient mix in 50 expert surgeons, motion analysis of intracorporeal knot tying could not significantly determine surgical outcome skills in advanced laparoscopic surgery.
Conclusion:
Levels of proficiency in advanced laparoscopic surgery cannot be appropriately determined using motion analysis in box trainers. Therefore, box trainer assessments do not adequately differentiate proficient from suboptimal clinical performance.
