Effects of Real Time Biofeedback on Open Surgery Suturing Skills Acquisition

Although the concept of suturing is simple, mastering it requires constant practice as plenty of things can go wrong and risk the patient's safety. This study aims to analyze medical students' open suturing learning curve when they train with a simulated tissue pad and are presented with different modes of real-time biofeedback on their performance.

A randomized controlled trial (RTC) was conducted, including 1 control group and 2 intervention groups (visual and haptic). Each group trained the 2-handed square flat knot task with a simulated tissue pad. This study consisted of a pretraining session, followed by 8 training sessions where biofeedback was used, a post-training session, and finally a follow-up session. A force measurement device was used to extract a total of ten force-related metrics to evaluate proficiency progression.

Between September 2023 and December 2023, this study was conducted at the author's institution's Faculty of Medicine.

Medical students without experience in knot tying techniques were considered eligible for the study. A total of 36 medical students were invited to participate in this study. Of the 36 students invited a total of 27 accepted the invitation (75% enrollment rate). All participants successfully finished the 11 sessions programmed in this study (0% dropout rate).

All groups improved their tissue handling skills; however, the visual and haptic groups achieved better performance than the control group. Analyzing the learning curve, it was found that the learning rate was similar for all groups, meanwhile the asymptote was usually lower for the intervention groups (Lower asymptotes imply higher tissue handling proficiency).

Real-time biofeedback can assist beginners in enhancing their tissue handling and developing greater proficiency in open-suture techniques.