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Randomized Controlled Trial
. 2024 Nov 19;24(1):1331.
doi: 10.1186/s12909-024-06266-5.

Application of spaghetti knotting technology in single-hole laparoscopic suturing instructional program on the basis of multi-directional stitching technology: a randomized controlled trial

Ziqi Chen #  1   2 , Sennan Zhu #  3 , Jiayu Tao  1   2 , Qiuyu Chen  4 , Wenzhuo Du  1   2 , Jindan Sun  1   2 , Mengqi Yu  1   2 , Yi Zhou  1   2 , Yu Zhao #  5 , Qiong Zhang #  6
Affiliations
Randomized Controlled Trial

Application of spaghetti knotting technology in single-hole laparoscopic suturing instructional program on the basis of multi-directional stitching technology: a randomized controlled trial

Ziqi Chen et al. BMC Med Educ. .

Abstract

Background: Spaghetti knotting technology is an emerging technique that can reduce the visual field restriction of the operator in laparo-endoscopic single site (LESS) surgery. Multi-directional stitching technology has been proved to improve the accuracy of suturing in clinical application of LESS surgery. Therefore, we conducted a study to evaluate the teaching efficacy and the operation workload of spaghetti knotting technology and conventional knotting technology in LESS suture teaching based on the multi-directional stitching technology.

Methods: We selected forty junior residents to learn the skill of knot tying with single-hole laparoscopic simulators. The forty students were randomly and equally divided into control group and experimental group. The control group was trained by the conventional knotting method, and the experimental group was trained by the spaghetti knotting technology. The grades were calculated before and after the training program, including operation score of suturing time, trhead length, needle insertion accuracy, knotting stability, tissue integrity, tissue tightness and the cognitive workload score of mental, physical and temporal demands, performance, effort and frustration.

Results: There was no significant difference between two groups before training. After training, knotting skills and workload were significantly improved. There were significant differences between the two groups in knotting time (p = 0.001), thread length (p = 0.01), and tissue integrity(p = 0.003). The experiment group took less time, left longer thread and had higher tissue integrity. The workload of the experiment group was also accurately reduced. However, there was no significant difference between the two groups in needle insertion accuracy(p = 0.560), knotting stability(p = 0.059), and tissue tightness(p = 0.731).

Conclusion: In LESS suture teaching based on the multi-directional stitching technology, the training of spaghetti knotting techniques significantly improved students' learning efficacy and reduced their workload compared to training conventional knotting techniques. It suggested the combination of spaghetti knotting and multi-directional stitching technology could be a practicable method for laparoscopic skills teaching and a feasible clinical application value on spaghetti knotting technology in LESS surgery.

Keywords: Laparo-endoscopic single site surgery; Laparoscopic knotting; Multi-directional stitching technology; Spaghetti knotting technology.

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Conflict of interest statement

Declarations Ethics approval and consent to participate This study has been performed in accordance with the Declaration of Helsinki and was reviewed by the Medical Ethics Committee of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University and the approval number is [2024-K-227-01]. All the participants included gave informed consent and acceptance to this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of study protocol
Fig. 2
Fig. 2
The format of multidirection stitch module
Fig. 3
Fig. 3
The schematic of spaghetti knotting technology
Fig. 4
Fig. 4
A: The total scores of NASA-TLX between the two groups before teaching; B: The data of NASA-TLX between the two groups before teaching
Fig. 5
Fig. 5
A: The total scores of NASA-TLX between the two groups after teaching; B: The data of NASA-TLX between the two groups after teaching
See this image and copyright information in PMC

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