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Objective assessment of endoscopic knot quality
G B Hanna1, T G Frank, A Cuschieri
1Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland.
American Journal of Surgery
|October 23, 1997
Summary
This study developed an objective method to assess surgical knot quality. The novel knot quality score (KQS) reliably measures knot security, strength, and tightening for endoscopic surgery.
Area of Science:
- Surgical Technology
- Biomechanical Engineering
- Minimally Invasive Surgery
Background:
- Surgical skill and ergonomics in endoscopic surgery are often evaluated using knot-tying tasks.
- An objective method is needed to assess the quality of surgical knots for research purposes.
Purpose of the Study:
- To establish an objective method for assessing the quality of surgical knots.
- To develop a reliable metric for evaluating knot security in endoscopic procedures.
Main Methods:
- Analyzed 2,700 endoscopic surgical knots using a tensiometer and computerized force-extension curve analysis.
- Assessed knot strength via breaking force and knot tightening via integrated force.
- Developed a knot quality score (KQS) based on breaking and integrated forces relative to an untied ligature.
Main Results:
- Knot quality score (KQS) was significantly higher for broken knots (25.3%) compared to slipped knots (7.1%).
- Breaking force and integrated force of knots were 71% and 35% of untied ligatures, respectively.
- The integrated force showed less variability for untied ligatures (3.5% SD) than for knots (37% SD).
Conclusions:
- The developed knot quality score (KQS) offers a reliable assessment of surgical knot security.
- KQS effectively reflects both the strength and the degree of tightening of surgical knots.