Real-time objective assessment of knot quality with a portable tensiometer is superior to execution time for assessment of laparoscopic knot-tying performance

Ritter, E. Matt; McClusky III, David A.; Gallagher, A. G.; Smith, C. Daniel; McClusky, David A 3rd
September 2005
Surgical Innovation;Sep2005, Vol. 12 Issue 3, p233
Academic Journal
journal article
Objective: Laparoscopic intracorporeal knot tying is a difficult skill to acquire. Currently, time to complete a knot is the most commonly used metric to assess the acquisition of this skill; however, without a measure of knot quality, time is a poor indicator of skills mastery. Others have shown that knot quality can be accurately assessed with a tensiometer, but obtaining this type of assessment has typically been cumbersome. We investigated a new method of real-time assessment of knot quality that allows for more practical use of knot quality as a performance metric.Methods: Eleven experienced endoscopic surgeons tied 100 intracorporeal knots in a standard box trainer. Each of the knots was immediately tested using the InSpec 2200 benchtop tensiometer (INSTRON, Canton MA) where a knot quality score (KQS) is generated based on the load handling properties of the knotted suture. The execution time was also recorded for each knot.Results: The assessment of all knots ended with one of two end points: knots that slipped (n=48) or knots that held until the suture broke (n=52). Knots that slip are generally of poorer quality than those that held. Execution time did not correlate with knot-quality score (r=0.009, P=.9), and the mean execution time did not differ significantly between slipped and held knots (65 vs 68 seconds, P=.8). No completion time criteria were able to accurately predict slipped versus held knots. The mean KQS difference between held and slipped knots was highly significant (24 vs 12, P<.0001). A knot with a KQS exceeding 20 was nearly 10 times more likely to hold than slip.Conclusion: Time to complete a knot is a poor metric for the objective assessment of intracorporeal knot-tying performance in the absence of a measure of knot quality. Real-time evaluation of the knot quality can accurately distinguish well-tied knots from poorly tied knots. This mode of assessment should be incorporated into training curriculum for surgical knot tying.


Related Articles

  • New models for advanced laparoscopic suturing: taking it to the next level. Watanabe, Yusuke; McKendy, Katherine; Bilgic, Elif; Enani, Ghada; Madani, Amin; Munshi, Amani; Feldman, Liane; Fried, Gerald; Vassiliou, Melina; McKendy, Katherine M; Feldman, Liane S; Fried, Gerald M; Vassiliou, Melina C // Surgical Endoscopy;Feb2016, Vol. 30 Issue 2, p581 

    Background: Current simulations for laparoscopic suturing do not reflect the complexity of the skills required in the operating room. The purpose of this study was to develop three novel advanced suturing tasks with assessment metrics and to collect validity evidence for their...

  • Laparoscopy Rein and a Backward Needle Entrance. Tsin, Daniel A.; Davila, Fausto; Dominguez, Guillermo; Tinelli, Andrea // Journal of Laparoendoscopic & Advanced Surgical Techniques;Jul/Aug2011, Vol. 21 Issue 6, p521 

    Since the awakening of single-port laparoscopy and culdolaparoscopy and with the increased interest in minilaparoscopy-assisted natural orifice surgery and pure natural orifice peritoneoscopy, laparoscopists are in pursuit of techniques with less percutaneous assistance. We made a rein using a...

  • News and notices.  // Surgical Endoscopy;Jul2008, Vol. 22 Issue 7, p1741 

    The article presents developments related to the field of endoscopic surgery. The laparoscopic courses offered at Colchester General Hospital in England are presented. The Cuschieri Skills Centre in Scotland provides high quality skills training aimed at improving surgical competence and...

  • The Surgical Safety Checklist: Lessons Learned During Implementation. CALLAND, JAMES FORREST; TURRENTINE, FLORENCE E.; GUERLAIN, STEPHANIE; BOVBJERG, VIKTOR; POOLE, GARRETT R.; LEBEAU, KELSEY; PEUGH, JAMES; ADAMS, REID B. // American Surgeon;Sep2011, Vol. 77 Issue 9, p1131 

    Procedural checklists may be useful for increasing the reliability of safety-critical processes because of their potential capacity to improve teamwork, situation awareness, and error catching. To test the hypothesized utility and adaptability of checklists to surgical teams, we performed a...

  • Laparoscopic Baseline Ability Assessment by Virtual Reality. Madan, Atul K.; Frantzides, Constantine T.; Sasso, Lisa M. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Feb2005, Vol. 15 Issue 1, p13 

    Background: Assessment of any surgical skill is time-consuming and difficult. Currently, there are no accepted metrics for most surgical skills, especially laparoscopic skills. Virtual reality has been utilized for laparoscopic training of surgical residents. Our hypothesis is that this...

  • A helping hand for urologic laparoscopy. Strup, Stephen E. // Contemporary Urology;Apr2006, Vol. 18 Issue 4, p43 

    Offers views regarding the future of hand-assisted laparoscopy in urology. Benefits of the surgical technique for urologic surgeons; Advantages in complex surgical procedures.

  • Can current technology be integrated to facilitate laparoscopic living donor hepatectomy? Lin, E.; Gonzalez, R.; Venkatesh, K. R.; Mattar, S. G.; Bowers, S. P.; Fugate, K. M.; Heffron, T. G.; Smith, C. D. // Surgical Endoscopy;May2003, Vol. 17 Issue 5, p750 

    Background: Living donor hepatectomy (LDH) is a technically demanding procedure that is an alternative for providing livers for transplantation. Unlike liver resections for other pathology, LDH requires preservation of the major vessels and biliary tree. This study was performed to determine if...

  • Determinants of plasma parathyroid hormone levels in young women. Paik, Julie M.; Curhan, Gary C.; Forman, John P.; Taylor, Eric N. // Calcified Tissue International;Sep2010, Vol. 87 Issue 3, p211 

    While the effects of calcium, phosphorus intake, and vitamin D on parathyroid hormone (PTH) have been well studied, less is known about other factors that impact PTH. Our goal was to delineate associations between demographic, dietary, and plasma factors and PTH. We conducted a cross-sectional...

  • Open-jaw technique in laparoscopic knot tying. Kawano, T.; Nishikage, T. // Surgical Endoscopy;Jan2008, Vol. 22 Issue 1, p269 

    The article offers technique in laparoscopic knot tying. The technique, which is called open-jaw method uses two grasping forceps for the tissue and a stitch needle. Knot tying was done by two forceps after the usual suture of the target tissues. When tying, it is necessary to open the jaws of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics