Intracorporal knot tying techniques - which is the right one?

Area of Science:

• Minimally Invasive Surgery (MIS)
• Surgical Education
• Laparoscopic Skills Training

Background:

• Intracorporeal knot tying (ICKT) is crucial for advanced MIS procedures like Nissen fundoplication.
• Suture placement under tension presents a significant challenge in MIS.
• Objective assessment of ICKT skills after standardized training is essential.

Purpose of the Study:

• To compare the quality and performance of the surgical square knot versus the slipping knot for ICKT under simulated tension.
• To objectively assess the impact of a 3-hour hands-on training program on surgical skill in ICKT.
• To evaluate knot tying performance, task time, and suture placement accuracy.

Main Methods:

• A box trainer with a simulated suture pad was used for laparoscopic knot tying.
• Twenty participants (senior physicians, residents, medical students) were divided into three groups.
• Participants performed square and slipping knot tying before and after a 3-hour training session, with parameters including knot quality, performance, time, and accuracy.

Main Results:

• The slipping knot demonstrated significantly superior knot quality compared to the square knot across all participant groups.
• No significant differences were found in knot tying performance, task time, or accuracy between the two knot types within groups.
• Medical students and surgical residents showed improvement in all assessed categories after the training program.

Conclusions:

• The slipping knot is superior in quality to the square knot for intracorporeal suturing under tension.
• A 3-hour training program effectively enhanced laparoscopic suturing and knot tying skills for all participants.
• Validated training programs should be integrated into surgical education for MIS.