Effect of training on endoscopic intracorporeal knot tying

Training in endoscopic, intracorporeal knot tying, was evaluated in 29 obstetrics and gynaecology trainees who performed 100 consecutive intracorporeal, two turn, flat, square knots. An obvious learning curve was observed. With training the quality of the knots increased, whereas the mean duration to tie a knot decreased from 277 +/- 114 to 67 +/- 27 s for the first 10 and the last 10 knots respectively. The initial and final duration of knot tying were lower in more experienced trainees, as estimated by the year of training or the Royal College of Obstetrics and Gynaecology (RCOG) level of experience. More specifically, duration of knot tying was shorter when more diagnostic laparoscopies, laparoscopic sterilizations or adnexectomies had been performed. This effect of previous experience was however limited compared with the overall effect of training. Previous passive experience, however, as determined by the number of assisted or observed surgical interventions, did not affect the learning curves. Speed of knot tying was slightly higher in trainees who spent more of their leisure time performing handicrafts than in trainees who were more interested in reading, but although significant, these differences were only marginal. In conclusion, the data show an important effect of training on the speed and quality of intracorporeal knot tying and confirm that learning curves improve with previous training.