Beyond the Square knot: A validation study for a novel knot-tying method named "inverse 9"

Area of Science:

• Surgical techniques
• Medical education

Background:

• Laparoscopic surgery requires proficiency in suturing and knot-tying (LSKT).
• Traditional LSKT methods can have a steep learning curve and cause operational fatigue.

Purpose of the Study:

• To compare the efficacy of the "inverse 9" LSKT method against the traditional LSKT method.
• To demonstrate the superiority and effectiveness of the "inverse 9" LSKT technique in laparoscopic training.

Main Methods:

• 78 surgical trainees were divided into inexperienced (Group A) and experienced (Group B) cohorts.
• Group A trainees were randomized to "inverse 9" (A1) or traditional (A2) LSKT training.
• Experienced trainees (Group B) were randomized to "inverse 9" (B1) or continued traditional (B2) LSKT training.

Main Results:

• Trainees in the "inverse 9" groups (A1, B1) achieved proficiency faster (5th assessment) than those in the traditional group (A2, 6th assessment).
• Groups A1 and B1 reported lower difficulty and operational fatigue.
• Over 61% of experienced trainees preferred the "inverse 9" method.

Conclusions:

• The "inverse 9" LSKT technique offers a simpler operation and reduces knot-tying time.
• It presents a shorter learning curve, facilitating easier mastery and wider adoption.
• The "inverse 9" method is a promising standard LSKT technique for surgical training.