1 Citation
Background: Suturing is one of the most challenging tasks in laparoscopic
surgery. Ensuring both the ease and speed of suturing has benefits not
only for the surgeon, but can dramatically decrease operating time.
Therefore, this study aimed to compare extracorporeal and intracorporeal
suturing techniques using a Szabo pelvic trainer model
from the Gynaecological Endoscopic Surgical Education and Assessment
program. Methods: Fifty-seven medical students with no experience in
laparoscopy performed intra and extracorporeal knots using closed and open
jaw knot pushers. Using an artificial tissue suturing pad in a
certified Szabo pelvic trainer, students made three knots using each
technique according to block randomization. Task completion time, knot
strength, knot-spread ability, and the number of errors were recorded. The
Wilcoxon test and mixed-effects models were used to analyze the results.
After completing the exercises, participants answered a questionnaire
concerning the suturing techniques and their performance. Results: Open
and closed extracorporeal suturing resulted in significantly faster
(P<0.001, P<0.001, respectively), more precise (P=0.007,
P=0.003) and decreased knot spread ability (P<0.001,
P<0.001) when compared to intracorporeal suturing. Open vs. closed
jaw knot pushers were shown to be equal in regard to speed (p=0.563), knot
spread ability (p = 0.49) and precision (p=0.831). Open (30%) and closed
(49%) extracorporeal suturing was rated as more intuitive than
intracorporeal (21%) suturing by study participants. Better concentration
was correlated with increased knot strength (p = 0.063) and significantly
tighter knots (p = 0.011). Conclusions: Students achieved significantly
better results using extracorporeal suturing techniques compared to
intracorporeal ones including greater speed, tighter knots, and optimized
precision. These results suggest that beginners in the field of
laparoscopy should be encouraged to practice extracorporeal suturing
techniques.