DOI: 10.5061/dryad.p2ngf1vvf
title: Intracorporeal vs. extracorporeal open and closed knot tying techniques in laparoscopy: A randomized, controlled study

description: 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&lt;0.001, P&lt;0.001,
 respectively), more precise (P=0.007, P=0.003) and decreased knot spread
 ability (P&lt;0.001, P&lt;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.
description: # Intracorporeal vs. extracorporeal open and closed suturing techniques in
 laparoscopy: A randomized, controlled study
 [https://doi.org/10.5061/dryad.p2ngf1vvf](https://doi.org/10.5061/dryad.p2ngf1vvf) This dataset comprises the data collected during the study "Intracorporeal vs. extracorporeal open and closed suturing techniques in laparoscopy: A randomized, controlled study". The study included 57 medical students with no prior experience in laparoscopic surgery. Participants performed intracorporeal and extracorporeal knots using both open and closed jaw-type knot pushers on a Gynaecological Endoscopic Surgical Education and Assessment (GESEA) certified pelvic trainer. The study involved three runs of knot-tying tasks for each technique, and primary outcome measures included task completion time, knot strength, knot-spread ability and mistakes. The dataset was analyzed using mixed-effects models to assess the impact of the different knot-tying techniques on various outcome measures. Key findings include that both extracorporeal knot-tying techniques were faster, resulted in tighter knots, and had fewer mistakes compared to the the intracorporeal knot-tying technique. Participants exhibited a learning curve, improving their performance over the three runs. ## Description of the data and file structure The enclosed excel data sheet "DATA_Knot-tying_FINAL" contains two data files: Knot-Tying_Data and Questionnaire_Data. The Knot-Tying_Data file shows for each "subject" (total 57 medical students) the randomized "sequence" in which the three different "knot-tying techniques" (A = intracorporeal, B = extracorporeal, open jaw, C = extracorporeal, closed jaw) were performed. "Run" shows the the first, second and third run of every knot-tying technique. "Time to catch needle", "time first loop", "time second loop", "time third loop" and "time total" are documented in seconds (s). "knot strength before 15 N" and "knot strength after 15 N" are measured and documented in millimeter (mm). The "delta knot strength" is calculated as "knot strength after 15 N" minus "knot strength before 15 N". The "knot spread ability" is measured in millimeter (mm). The number of "mistakes" are documented by the investigator and measured in numbers (1-3). "N/A" means not available, meaning that the specific "run" was at some point faulty and therefore the following measurements weren't available = couldn't be measured. The Questionnaire_Data file displays for each "subject" personal information like "gender" (f = female, m = male), "age range" (1 = 20 years; 2= 25 years; 3 &gt; 25 years), the current "semester range" at time of the study (1 = semester 1+2; 2 = semester 3+4; 3 = semester 5+6; 4 = semester 7+8; 5 = semester 9+10; 6 = semester 11+12) as well as the "future specialization" (1 = more likely surgery, 2 = more likely medicine, 3 = unknown). Furthermore the students ("subject") answered the following questions "How often do you play video games?" (0 = never, 10 = daily), "Do you play ball sports" (1 = No, 2 = Yes) and "Do you play a musical instrument" (1 = No, 2 = Yes). After completing all three knot tying techniques the students ("subject") answered another questionnaire with the following questions "How was your ability to concentrate in technique A?" (0 = very bad, 10 = very good), "How was your ability to concentrate in technique B?" (0 = very bad, 10 = very good), "How was your ability to concentrate in technique C?"(0 = very bad, 10 = very good) and finally "Which suturing technique was the most intuitive?" (A = intracorporeal, B = extracorporeal, open jaw, C = extracorporeal, closed jaw).