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Influence of training on reliability of surgical knots

  1. Thomas E. J. Ind1,*,
  2. Julia C. Shelton2,
  3. John H. Shepherd1

Article first published online: 22 DEC 2003

DOI: 10.1111/j.1471-0528.2001.00251.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 108, Issue 10, pages 1013–1016, October 2001

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How to Cite

Ind, T. E. J., Shelton, J. C. and Shepherd, J. H. (2001), Influence of training on reliability of surgical knots. BJOG: An International Journal of Obstetrics & Gynaecology, 108: 1013–1016. doi: 10.1111/j.1471-0528.2001.00251.x

Author Information

  1. 1

    The Gynaecological Cancer Centre, St Bartholomew's Hospital, London, UK

  2. 2

    Medical Engineering Division, Department of Engineering, Queen Mary, University of London, UK

**Dr T. Ind, Senior Registrar, Department of Gynaecological Oncology, Mulberry House, Royal Marsden Hospital, Fulham Road, London, UK

Publication History

  1. Issue published online: 22 DEC 2003
  2. Article first published online: 22 DEC 2003
  3. Accepted 26 June 2001

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Objectives To determine whether trainees in obstetrics and gynaecology tie adequate surgical knots and to assess whether formal training improves knot tying skills.

Design A comparative study assessing surgical knots before and after tuition.

Population Fourteen trainees in a single obstetrics and gynaecology department.

Setting A basic surgical skills workshop based in a London teaching hospital.

Methods Trainees tied surgical knots around a 120mm jig using 2/0 glycan polymer. Each trainee tied 11 knots before and after a two and a half hour teaching session. Knots were tested using a mechanical testing machine.

Outcome measures Knot strength (N); proportion of knots that were ‘secure’ (defined as those that eventually failed on the testing device by breakage rather than slippage); proportion of knots that were ‘dangerous’ (defined as those with a tensile strength of < 5 N).

Results After tuition, the median knot strength of the whole group was 5.7 N stronger than before instruction (95% CI 4.6–12.3 N). Prior to tuition 13.5% (20/148) knots tied had a tensile strength of < 5 N. This was compared with 3.4% (5/148) after tuition (OR = 0.2, 95% CI 0.1–0.6). Before instruction 55.4% (82/148) of the knots were secure compared with 66.9% (99/148) after tuition (OR = 1.6, 95% CI 1.0–2.7).

Conclusion Knot tying workshops can improve the ability of trainees in obstetrics and gynaecology to tie reef knots.

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