How to Master the Complex Task of Laparoscopic Suturing and Intra-Corporeal Knot Tying Using the Novel Clock Face Logic

Abstract

Video Objective The aim was to design a reproducible, easy to adopt method for teaching laparoscopic suturing and intracorporeal knot tying. The novel use of a clock face to guide the steps is proposed to simplify & accelerate skill acquisition. The technique appears far easier to conceptualize than many others and has been very positively received during laparoscopic masterclasses conducted at the Centre for Advanced Reproductive Endo-surgery in Sydney, Australia. Setting Laparoscopic suturing requires very different and more advanced skill sets compared to suturing at open procedures. Proficiency with these skills is essential for the completion of advanced minimally invasive gynecological procedures such as hysterectomy, myomectomy and sacrocolpopexy. Inadequate laparoscopic suturing skills have been identified as a key factor impeding the use and greater adoption of minimally invasive techniques for most gynecologists. Laparoscopic suturing is one of the most difficult skills in minimally invasive surgery due to multiple factors including a constrained working field, altered depth perception, the need for counterintuitive movements and also the lack of a standardized teaching technique. Interventions This video uses images and footage from a simulation laboratory to clearly illustrate the steps involved in mastering laparoscopic suturing and intracorporeal knot tying using novel clock face directions to guide the movements. Conclusion This technique has been successfully incorporated into masterclasses run at the Centre, where anecdotally participants have grasped the concepts involved in laparoscopic suturing more quickly than with previous techniques. A prospective study is planned to compare the use of the novel clock face instructional teaching to more conventional terminology.