BACKGROUND: Studies of the surgeon's skill and the ergonomics of task
performance in endoscopic surgery can be based on knot-tying tasks, Th
e aim of this study was to establish an objective method for assessing
the quality of surgical knots for use in such studies. METHODS: In al
l, 2,700 surgeon's endoscopic knots were studied. Each knot was distra
cted using a tensiometer, and a computerized system analyzed force-ext
ension curves, The breaking force was taken as an index of knot streng
th while the force integrated over the slope of the curve reflected kn
ot tightening, A knot quality score (KQS) was obtained from the produc
t of the knot-breaking force and the integrated force expressed as a p
ercentage of the product for the untied ligature. RESULTS: The mean br
eaking force (24 Newton +/- 2.5) and integrated force (7.4 Newton +/-
2.8) for broken knots were 71% and 35%, respectively, of those for unt
ied ligature. The integrated force yielded a narrower range of variabi
lity for untied ligature (SD 3.5% of mean) than for knots (SD 37% of m
ean), The KQS was higher for broken (25.3% +/- 10.3%) than slipped kno
ts (7.1% +/- 5.1%), CONCLUSION: The KQS provides a reliable assessment
of knot security and reflects the strength and degree of tightening o
f the knot. (C) 1997 by Excerpta Medica, Inc.