The Effect on Performance Time and Quality of the Knots after Mono or Bimanual Training of Laparoscopic Intracorporeal Knot Tying according to the Gladiator Rule Technique

Abstract Objective To assesswhether themonomanual or bimanual training of laparoscopic suture followingthe sametechniquemay interferewith theknots’ performancetimeand/or quality. Methods A prospective observational study involving 41 resident students of gynecology/ obstetrics and general surgery who attended a laparoscopic suture training for 2 days. The participants were divided into two groups. Group A performed the training using exclusively their dominant hand, and group B performed the training using both hands to tie the intracorporeal knot. All participants followed the same technique, called Romeo Gladiator Rule. At the end of the course, the participants were asked to perform three exercises to assess the time it took them to tie the knots, as well as the quality of the knots. Results A comparative analysis of the groups showed that there was no statistically significant difference (p = 0.334) between them regarding the length of time to tie one knot. However, when the time to tie 10 consecutive knots was compared, group A was faster than group B (p = 0.020). A comparison of the knot loosening average, in millimeters, revealed that the knots made by group B loosened less than those made by group A, but there was no statistically significant difference regarding the number of knots that became untied. Conclusion This study demonstrated that the knots from group B showed better quality than those from group A, with lower loosening measures and more strength necessary to untie the knots. The study also demonstrated that group A was faster than B when the time to tie ten consecutive knots was compared.

摘要 研究目的：评估采用同一技术开展腹腔镜缝合单手训练与双手训练，是否会对打结的操作时间及/或打结质量产生影响。方法：本研究为前瞻性观察性研究，纳入41名妇产科学与普通外科学住院医师，所有受试者均参与为期2天的腹腔镜缝合训练课程。将受试者分为两组：A组仅使用优势手完成训练，B组则使用双手进行腔内打结训练。所有受试者均采用统一的训练技术——罗马角斗士法则（Romeo Gladiator Rule）。课程结束后，要求受试者完成三项打结操作任务，以评估其打结耗时与打结质量。结果：组间对比分析显示，单结打结时长无统计学显著性差异（p=0.334）。但在连续打结10次的总耗时对比中，A组的操作速度快于B组（p=0.020）。对以毫米为单位的打结松弛度平均值进行比较，结果显示B组所打结扎的松弛程度小于A组，但两组间的脱结数量无统计学显著性差异。结论：本研究表明，B组所打结扎的质量优于A组，其松弛程度更低，且解开结所需的拉力更大。同时，连续打结10次的总耗时对比显示，A组的操作速度快于B组。