title: Force feedback vessel ligation simulator in knot-tying proficiency training.
abstract: BACKGROUND
  Tying gentle secure knots is an important skill. We have developed a force feedback simulator that measures force exerted during knot tying. This pilot study examines the benefits of this simulator in a deliberate practice curriculum.
  
  
  METHODS
  The simulator consists of silastic tubing with a force sensor. Knot quality was assessed using digital caliper measurement. Participants performed 10 vessel ligations as a pretest, then were shown force readings and tied knots until reaching proficiency targets. Average peak forces precurriculum and postcurriculum were compared using Student t test.
  
  
  RESULTS
  Participants exerted significantly less force after completing the curriculum (.61 N ± .22 vs 1.42 N ± .53, P < .001), and had fewer air knots (10% vs 27%). The curriculum was completed in an average of 19.4 ± 6.27 minutes and required an average of 11.7 ± 4.03 knots to reach proficiency.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of real-time feedback in learning to tie delicate knots. The curriculum can be completed in a reasonable amount of time, and may also work as a warm-up exercise before a surgical case.
authors.affiliation: Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0737, USA.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Hsu
authors.affiliation: Department of Surgery, Tulane University School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Korndorffer
authors.affiliation: Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0737, USA. Electronic address: kim.brown@utmb.edu.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Brown
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education; D000068156:Formative Feedback; D013502:General Surgery / Q000193:education*; D006801:Humans; D008026:Ligation / Q000193:education; D010865:Pilot Projects; D000066908:Simulation Training; D013536:Suture Techniques / Q000193:education*
keywords: Curriculum; Force feedback; Knot-tying; Simulation; Surgical training; Vessel ligation