Suturing techniques of individual surgeons —Differences in accuracy and mechanics—

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Abstract
The suturing techniques of fifteen surgeons with similar surgical experience were evaluated with respect to pinpoint accuracy and the force produced while suturing. Subjects were randomly selected from a group of surgeons whose surgical experience ranged from five to six years. Accuracy was determined by the deviated distance between the needle exit and the designated exit. Force was expressed as torques (F) loaded on a needle holder, and included the derivatives (dF/dt) and integrals (IF). Suturing times (T) were also measured. Ten attempts at suturing were allowed, using each of the following two methods: 1) allowing adjustment by wavering the needle to improve accuracy, and 2) suturing without wavering the needle. The differences in technique, on an individual basis, were highly significant. The accuracy and the mechanics, including the maximum F, maximum dF/dt, IF, IF/T, and T, all had a p-value of less than 0.0001. The surgeons’ ranks according to these variables were also concordant, the Kendall’s coefficients of concordance (W) being 0.60 (p=0.002) for suturing done without wavering and 0.56 (p=0.005), for that done with wavering. It was concluded that the surgeons’ skill in suturing techniques differed significantly among individuals and that the surgeons’ ranks according to the variables were also concordant. Thus, formal training in suturing techniques should be established as part of the training of all surgeons.

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