Towards a better knot: Using mechanics methods to evaluate three knot-tying techniques in laparo-endoscopic...

Area of Science:

• Minimally Invasive Surgery
• Surgical Skill Assessment
• Biomechanical Analysis

Background:

• Knot tying is a critical skill in laparo-endoscopic single-site surgery (LESS).
• Objective assessment methods for LESS knot-tying skills are lacking.
• This study evaluates three LESS knot-tying techniques using mechanical parameters.

Purpose of the Study:

• To objectively assess and compare three distinct knot-tying techniques in LESS.
• To evaluate the mechanical performance and strength of knots tied using different LESS methods.

Main Methods:

• Three knot-tying techniques were performed by a subject in a laparoscopic trainer.
• Instrument movements were analyzed using a LESS mechanical evaluation platform.
• Knot strength was measured by tensile force to rupture using a material testing system.

Main Results:

• The intracorporeal one-hand technique demonstrated significantly better time and average load scores than the extracorporeal technique (P < 0.01).
• The intracorporeal side winding technique was more time and load consuming than other methods (P < 0.01).
• Knots from the intracorporeal one-hand technique withstood greater distraction forces than the other two techniques (P < 0.05).

Conclusions:

• The intracorporeal one-hand knot-tying technique is superior in terms of time, average load, and knot strength.
• This technique offers better mechanical performance and knot security compared to side winding and extracorporeal methods in LESS.