Surgery Clinical Trial
Official title:
Evaluating the Burst Pressure of Simulated Bowel Anastomosis Constructed Using the Reverse Half-Hitch Alternating Post Knots
Square knots are the gold standard for hand-tied surgical knots; however, they are difficult
to reproduce in deep body cavities and can inadvertently result in slipped knots. The
investigators have shown in previous work that the reversing half-hitch alternating post
(RHAP) surgical knot is a non-inferior alternative to the square surgical knot based on its
tensile strength and performance in limited working spaces. Prior to introducing RHAP knot in
routine surgical practice, it is important to objectively demonstrate similar physical
characteristics of anastomosis created using RHAP and standard square knots. This study aims
to compare the burst pressure of cadaveric porcine small bowel anastomosis constructed using
RHAP and standard square knots on a flat surface and in a simulated deep body cavity.
The investigators are conducting a prospective randomized controlled study of novice medical
students allocated to proficiency-based training in RHAP and square surgical knots. Knot
tying proficiency will be assessed using a knot-tying checklist. Number of repetitions and
time required to achieve proficiency will be tracked for each group. Once proficiency has
been achieved by participants in RHAP and square knots group, each participant will perform
two-hand sewn small bowel anastomosis using cadaveric porcine small bowel. One anastomosis
will be performed on a flat surface and the other will be formed in a simulated deep body
cavity. Burst pressure of the anastomoses will be tested using a column of water, and results
will be compared between groups. Simple descriptive statistics will be performed for both
groups. Between group comparisons of knot-tying proficiency and burst pressure will be
performed using t-test. Learning curves within each group will be analyzed using paired 1-way
ANOVA. SPSS Statistics (v. 21, IBM, New York, USA) will be used for all statistical analysis,
with significance set to p<0.05.
The investigators hypothesize that burst pressure of cadaveric porcine small bowel
anastomosis will be equivalent for anastomosis constructed using RHAP and standard square
knots.
The results of this study will provide further validity evidence in support of RHAP as
suitable alternative to the square surgical knots.
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