title: Intracorporal suturing--driving license necessary?
abstract: BACKGROUND
  Intracorporeal suturing and knot tying (ICKT) in minimal invasive surgery (MIS) represents a key skill for advanced procedures. Different methods exist for measuring knot quality and performance, but the heterogeneity of these methods makes direct comparisons difficult. The aim of this study is to compare the quality of a laparoscopic knot to one that is performed open.
  
  
  METHODS
  To compare open and laparoscopic knot-tying methods we used a surgeon's square knot. For laparoscopic knot tying we used a Pelvitrainer. The 32 participants were divided among 4 groups of different skill levels. Group 1 consisted of 6 senior physicians. Group 2 was made up of 10 first to fourth year interns. Groups 3 and 4 contained 16 medical students who had never performed either laparoscopic procedures or open sutures before. Group 3 participants received a 1-hour hands-on training in suturing, whereas group 4 participants received no prior training. Total time, knot quality, suture placement accuracy, and performance defined the parameters for assessment in this study.
  
  
  RESULTS
  All participants, irrespective of education level were inferior in ICKT compared to open suturing. Only Group 1 showed no significant difference in knot quality and accuracy between the open and laparoscopic suture performance.
  
  
  CONCLUSIONS
  It is well documented that psychomotor skills need to be developed before more advanced skills can be put into practice. Training centres for minimally invasive surgery should be an integral part of surgical education. The variables in our study are meaningful and easy to implement. They can be used to measure personal progress and as objective parameters in the development of laparoscopic trainee education.
authors: Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Electronic address: Philipp.Romero@med.uni-heidelberg.de.
authors: P
authors: P
authors: Romero
authors: Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors: O
authors: O
authors: Brands
authors: Department of Surgery and German Cancer Centre, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors: F
authors: F
authors: Nickel
authors: Department of Surgery and German Cancer Centre, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors: B
authors: B
authors: Müller
authors: Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors: P
authors: P
authors: Günther
authors: Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors: S
authors: S
authors: Holland-Cunz
mesh_terms: D002983:Clinical Competence; D013502:General Surgery; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008007:Licensure, Medical; D013536:Suture Techniques / Q000193:education* / Q000592:standards*; D013647:Task Performance and Analysis; D013997:Time Factors
keywords: Intracorporeal knot tying; Intracorporeal suturing; Minimal invasive surgery