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Surgical sutures: coincidence or experience?
K-T von Trotha1, J Grommes2, N Butz3
1Department of Vascular and Endovascular Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. kvontrotha@ukaachen.de.
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|April 10, 2017
Summary
Surgical suture tension during hand-knotting is not reproducible and does not improve with surgeon experience. Individual feeling, not expertise, dictates knotting tension in surgical procedures.
Area of Science:
- Surgical technique
- Biomechanical analysis
- Medical device engineering
Background:
- Hand-knotting sutures remains a critical skill in surgical procedures like laparotomy closure.
- Surgeon experience and subjective judgment are traditionally believed to influence suturing technique.
- The reproducibility of suture tension in manual knotting has not been thoroughly investigated.
Purpose of the Study:
- To determine if suture tension applied during manual knotting is reproducible.
- To assess the impact of surgical experience on the reproducibility of suture tension.
- To investigate the consistency of manual suturing techniques in surgical practice.
Main Methods:
- 118 surgeons performed five repetitive sutures on a certified tension-measuring device.
- Surgeons were categorized into five experience-based subgroups (0-30+ years).
- Suture tension was measured in Newtons during the knotting process.
Main Results:
- Measured suture tension varied widely, ranging from 0.19 to 10 N.
- Mean suture tension showed no significant difference across experience groups.
- Suture tension was found to be irreproducible, irrespective of the surgeon's experience level.
Conclusions:
- Manual suture tension is not reproducible, even among highly experienced surgeons.
- Current suturing tension appears to be based on subjective estimation rather than objective measurement.
- Further research is needed to define ideal, tissue-dependent suture tension standards.