title: Evaluation of a novel modified suture material designed to facilitate intracorporeal knot tying during laparoscopic surgery.
abstract: OBJECTIVE
  Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is an arduous process with a long learning curve. While recent advances in instrumentation have allowed easier suturing and tying, until now, no attempts have been made to modify the suture material in order to facilitate this process. We present an evaluation of a novel modified suture material designed to allow inexperienced surgical residents to tie intracorporeal knots laparoscopically using conventional laparoscopic needle drivers.
  
  
  METHODS
  Surgical residents with no prior experience in laparoscopic surgery were invited to take part in this investigation. Each of the 14 participants was given a 10-minute demonstration of laparoscopic intracorporeal knot tying and then allowed a mentored practice session of 10 minutes. In the first trial, they were then randomized to tie a laparoscopic knot with either a standard or a modified dry suture. Time and accuracy scores were recorded. They then performed the same task with the other type of suture. On the second trial, wet standard and modified sutures were used, and the order of the sutures used in the first trial was reversed.
  
  
  RESULTS
  The average time taken to tie an intracorporeal knot laparoscopically was significantly less when the modified suture was used in both dry and wet conditions (162.71 +/- 10.79 seconds v 270.86 +/- 22.76 seconds; P = 0.0039, and 123.29 +/- 4.70 seconds v 247.57 +/- 23.17 seconds; P = 0.0032, respectively). No significant difference in accuracy scores was noted with the two sutures.
  
  
  CONCLUSIONS
  Our modified suture design allowed inexperienced surgical residents to perform intracorporeal laparoscopic knot tying on average faster than the standard suture did. The concept of modifying suture design to facilitate laparoscopic suturing and knot tying deserves further investigation and development.
authors.affiliation: Department of Urology, University of Western Ontario, London, Ontario, Canada. andrew.tan@mac.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Tan
authors.forename: Hassan
authors.initials: H
authors.lastname: Razvi
mesh_terms: D002983:Clinical Competence; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D013536:Suture Techniques / Q000193:education* / Q000295:instrumentation; D013537:Sutures