title: Objective assessment of endoscopic knot quality.
abstract: BACKGROUND
  Studies of the surgeon's skill and the ergonomics of task performance in endoscopic surgery can be based on knot-tying tasks. The aim of this study was to establish an objective method for assessing the quality of surgical knots for use in such studies.
  
  
  METHODS
  In all, 2,700 surgeon's endoscopic knots were studied. Each knot was distracted using a tensiometer, and a computerized system analyzed force-extension curves. The breaking force was taken as an index of knot strength while the force integrated over the slope of the curve reflected knot tightening. A knot quality score (KQS) was obtained from the product of the knot-breaking force and the integrated force expressed as a percentage of the product for the untied ligature.
  
  
  RESULTS
  The mean breaking force (24 Newton +/- 2.5) and integrated force (7.4 Newton +/- 2.8) for broken knots were 71% and 35%, respectively, of those for untied ligature. The integrated force yielded a narrower range of variability for untied ligature (SD 3.5% of mean) than for knots (SD 37% of mean). The KQS was higher for broken (25.3%+/-10.3%) than slipped knots (7.1%+/-5.1%).
  
  
  CONCLUSIONS
  The KQS provides a reliable assessment of knot security and reflects the strength and degree of tightening of the knot.
authors.affiliation: Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland.
authors.forename: G B
authors.initials: GB
authors.lastname: Hanna
authors.forename: T G
authors.initials: TG
authors.lastname: Frank
authors.forename: A
authors.initials: A
authors.lastname: Cuschieri
mesh_terms: D002983:Clinical Competence; D004724:Endoscopy / Q000379:methods / Q000592:standards*; D006801:Humans; D013536:Suture Techniques / Q000592:standards*; D013537:Sutures; D013718:Tensile Strength; D013997:Time Factors