The Suturing and knot tying Training and Testing model

Training & assessment of laparoscopic stitching & knotting skills

Training in laparoscopic surgery is a real challenge. The actual pressure surrounding the surgical practice imposes evidently a validated quality control programme. This control starts by a standardization of the surgical training. The European Academy succeeded to elaborate a programme of training and certification dealing with both the theoretical knowledge on instrumentation, OR organisation, anatomy and complication management, and the practical laparoscopic psychomotor skills, including suturing and knot tying skills.

It remains without doubt that this is only the first but an important step in a professional training programme in laparoscopic gynaecological surgery but it certainly helps to answer the question:

“Are you good enough to offer your patient the laparoscopic approach for her surgery?”

Objectives

+he Academy has also developed a model to train and test more complex and fine LPS: The Suturing and knot tying Training and Testing model (SUTT). A series of tests on stitching and knotting has been defined to assess, independent of the medical skills, the required quality levels of suturing skills. If you have a laptop, you have the possibility to perform the suturing exercises with the E-Knot, a new home trainer to train specifically on the challenging skills of laparoscopic suturing and knot tying.

Excercises

Each participant will execute 4 exercises evaluating the needle manipulation, stitching, intra-corporeal knotting and tissue approximation using both dominant and non-dominant hand. The exercises are performed in a standard pelvi-trainer with a 0° 10 mm optic and 2 needle holders on the official SUTT pad. Position of the trocars cannot be changed between exercises but the mentee can position at its own discretion. The camera is manipulated by an assistant.

The exercises becomes increasingly difficult depending on the level. The exercises are evaluated by several criteria, including time to correct the performed exercise, correct pathway of the needle through the predefined dots,knot quality, tissue approximation and absence of trauma.

SUTT 1: Bachelor level

SUTT 1 is developed for the bachelor level. With your dominant hand you will have to make 4 stiches with cutting the threads and one with knot tying.

SUTT 2: MIGS level

EXERCISE 1: Stitching Greek Suture

Loading the needle with both hands starting to pass the needle through the red dot – running the suture until the last black dot. Alternating stitching hand after each 2 dots. Passing the tissue with a precise entry and exit in the centre of the dots. Manipulation of the thread, avoiding to tear the tissue.

EXERCISE 2: Stitching and knot tying with right hand

Precise positioning of stitch on the predefined entry (red dot) and exit point (black dot). 1 Intra-corporeal knot with double flat knot, 1st locking sequence and 2nd locking sequence. The exercise is being timed till the participant releases the thread at both ends at the end of the knotting movements.

EXERCISE 3: Stitching and knot tying with left hand

Precise positioning of stitch on the predefined entry (red dot) and exit point (black dot). 1 Intra-corporeal knot with double flat knot, 1st locking sequence and 2nd locking sequence. The exercise is being timed till the participant releases the thread at both ends at the end of the knotting movements.

EXERCISE 4: Stitching, tissue approximation and knot tying with dominant hand

Precise positioning of stitch on the predefined entry and exit point with dominant hand. Correct approximation of tissue by performing an intra-corporeal double flat knot with 2 locking sequences. The exercise is being timed till the participant releases the thread at both ends at the end of the knotting movements.

SUTT

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