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A Simulation Suture Compared With a Clinical Suture for Training on Laparoscopic Simulators: Objective Measurements
Yazan Aljamal1, Daniel E Johnson, Todd J Summerson
1From the Mayo Clinic Multidisciplinary Simulation Center (Y.A., D.E.J., T.J.S., T.E.B.), Mayo Clinic College of Medicine and Science; Department of Surgery (Y.A.), Mayo Clinic; and Materials and Structural Testing Core (A.R.T., D.R.F.), Mayo Clinic, Rochester, MN.
Objective:
Simulation sutures are a low-cost option for training purposes, but they may not perform as well as the more expensive clinical suture. Trainees at our institution have raised concerns about their quality and integrity compared with clinical suture. The objective was to determine whether significant differences in strength of the sutures and knot holding capabilities between low and high-cost sutures existed.
Methods:
Two sutures were compared: 3-0 braided silk simulation suture (Sim*Vivo LLC, Willsboro, NY) and 3-0 Perma-Hand silk braided clinical suture (Ethicon, Somerville, NJ). The diameter of the suture was assessed with light microscopy. Tensile strength of the suture and knotted suture were assessed. Both sutures were tested dry and wet.
Results:
Tensile strength of the sutures, knotted or unknotted, were not significantly different. Knot type did not change this comparison. Soaking in saline did not change the tensile strength but did introduce a substantial difference in knot failure mode between sutures. The mean diameter of the Ethicon suture was larger than that of the Sim*Vivo suture, which could influence suture behavior.
Conclusions:
The applied mechanical tests identified that clinical and simulation sutures differ some in their inherent mechanical characteristics related to suture handling. However, these differences did not translate to a key measure of performance of a sutured junction, namely, the strength of the knotted suture. Based on the results of the study, any subjective impressions of simulation suture strength and knot holding should not negatively impact its use for medical education.
