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. Matthew; McClusky, David A.; Gallagher, Anthony G.; Smith, C. Daniel

doi:10.1177/155335060501200308

Cited by 51 publications

(43 citation statements)

References 7 publications

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“…Ritter et al showed that the knot quality measured with a tensiometer was superior to execution time for the assessment of laparoscopic knot-tying performance [10]. The objectivity of the assessment could have been further increased if we had determined the quality of the knot as well, for example, by determination of the knot quality score.…”

Section: Discussionmentioning

confidence: 99%

Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial

et al. 2007

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Background Laparoscopic suturing is one of the most difficult tasks in endoscopic surgery, requiring extensive training. The aim of this study was to determine the transfer validity of knot-tying training on a virtual-reality (VR) simulator to a realistic laparoscopic environment. Methods Twenty surgical trainees underwent basic eyehand coordination training on a VR simulator (SIMENDO, DelltaTech, Delft, the Netherlands) until predefined performance criteria were met. Then, they were randomized into two groups. Group A (the experimental group) received additional training with the knot-tying module on the simulator, during which they had to tie a double laparoscopic knot ten times. Group B (controls) did not receive additional manual training. Within a week the participants tied a double knot in the abdominal cavity of an anaesthetized porcine model. Their performance was captured on digital video and coded. Objective analysis parameters were: time taken to tie the knot and number of predefined errors made. Subjective assessments were also made by two laparoscopic surgeons using a global rating list with a five-point Likert scale. Results Trainees in group A (n = 9) were significantly faster than the controls (n = 10), with a median of 262 versus 374 seconds (p = 0.034). Group A made a significantly lower number of errors than the controls (median of 24 versus 36 errors, p = 0.030). Subjective assessments by the laparoscopic experts did not show any significant differences in economy of movement and erroneous behavior between the two groups. Conclusion Surgical trainees who received knot-tying training on the VR simulator were faster and made fewer errors than the controls. The VR module is a useful tool to train laparoscopic knot-tying. Opportunities arose to improve simulator-based instruction that might enhance future training.

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Section: Discussionmentioning

confidence: 99%

Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial

et al. 2007

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“…The first VR simulators in surgery (e.g., the MIST VR [20]) presented abstract tasks with geometric bodies in a synthetic environment, using single criterions such as time to complete a trial or counting of errors, for both validation and assessment. However, it is doubtful whether these common metrics are sufficient to assess surgical performance comprehensively [21][22][23][24][25]. Recent high-fidelity simulators present very realistic simulated surgical scenes, implementing more and more combinations of metrics and scoring systems which express common clinical skills, e.g., ''economy of movements'' [17] or ''precision'' [25].…”

Section: Introductionmentioning

confidence: 99%

Establishing construct validity of a virtual-reality training simulator for hysteroscopy via a multimetric scoring system

et al. 2009

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“…Moreover, vaginal closure is obtained with the placement of a single intra-corporeal knot. The fact that we have not experienced any unsecured or unraveled knots is compelling, particularly given the high frequency of knot slippage reported in previous studies [10,11].…”

Section: Discussionmentioning

confidence: 87%

“…Many techniques have been devised to facilitate extracorporeal and intra-corporeal knot suturing in a costeffective and efficient manner [10][11][12][13]. In terms of extra-corporeal knot tying, the Roeder procedure employs a spiral sliding knot that expands with humidity, ensuring knot security and reliability [10].…”

Section: Discussionmentioning

confidence: 99%

The Minailo knot: a time-saving and cost-saving technique

et al. 2010

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Endoscopic knot tying during minimally invasive surgery can be complicated, time consuming, and associated with a protracted learning curve. The Minailo knot seems to be a reasonable option because the technique does not require any specialized instrumentation or skill to perform. In particular, vaginal closure is obtained with the placement of a single intra-corporeal knot. Our initial and successful experience with this knot-tying technique during robotic hysterectomy for treatment of gynecologic disease suggests that the method is safe and feasible.

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Real-Time Objective Assessment of Knot Quality With a Portable Tensiometer Is Superior to Execution Time for Assessment of Laparoscopic Knot-Tying Performance

Cited by 51 publications

References 7 publications

Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial

Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial

Establishing construct validity of a virtual-reality training simulator for hysteroscopy via a multimetric scoring system

The Minailo knot: a time-saving and cost-saving technique

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