Influence of training on reliability of surgical knots

BJOG. 2001 Oct;108(10):1013-6. doi: 10.1111/j.1471-0528.2001.00251.x.


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.

Publication types

  • Comparative Study

MeSH terms

  • Clinical Competence / standards
  • Education, Medical, Graduate*
  • General Surgery / education*
  • Gynecology / education
  • Humans
  • Obstetrics / education
  • Suture Techniques / standards*