Laparoscopic Intracorporeal Knot Research Articles

ThTP3.1 Development and early validation of ‘SuturePal’: a novel mixed reality laparoscopic suturing training module

Abstract Aims Laparoscopic suturing is a challenging skill to acquire, requiring extensive training. This study aims firstly to develop a novel self-directed mixed reality laparoscopic suturing training module using the Microsoft Hololens 2 headset and secondly to assess the feasibility of this training tool and advantages over conventional training methods. Methods SuturePal is a self-directed mixed reality training module which combines didactic videos, text, and bespoke interactive 3D models. Ten medical students and surgical trainees participated in a single-blinded prospective randomised feasibility study. Participants received baseline teaching for laparoscopic intracorporeal knot tying and were subsequently randomised to either SuturePal (n=5) or conventional training (n=5). Baseline and post-training knots were recorded and assessed by two blinded examiners for time taken, precision, errors, and proficiency according to two previously validated objective assessment tools. Cognitive load was measured via the validated NASA-TLX tool and participant feedback was recorded. Results SuturePal users reported higher confidence levels (p=0.0476) and lower mental demand (p=0.0397) following training compared to those taught by conventional means. No statistical differences, however, were shown between groups when comparing objective measures of knot tying performance. Conclusions SuturePal provides evidence for how mixed reality technology may enhance engagement in surgical skill acquisition by improving user experience and lowering mental demand. This contributes to the growing body of evidence that mixed reality may have a role in enhancing surgical training. However, further research in the form of larger scale studies is required to determine whether mixed reality improves objective performance of surgical trainees.

Comparing Simulator Metrics and Rater Assessment of Laparoscopic Suturing Skills

Laparoscopic intracorporeal suturing is important to master and competence should be ensured using an optimal method in a simulated environment before proceeding to real operations. The objectives of this study were to gather validity evidence for two tools for assessing laparoscopic intracorporeal knot tying and compare the rater-based assessment of laparoscopic intracorporeal suturing with the assessment based on simulator metrics. Twenty-eight novices and 19 experienced surgeons performed four laparoscopic sutures on a Simball Box simulator twice. Two surgeons used the Intracorporeal Suturing Assessment Tool (ISAT) for blinded video rating. Composite Simulator Score (CSS) had higher test-retest reliability than the ISAT. The correlation between the number performed procedures including suturing and ISAT score was 0.51, p<0.001, and 0.59 p<0.001 for CSS. We found an inter-rater reliability (0.72, p<0.001 for test 1 and 0.53 p<0.001 for test 2). The pass/fail rates for ISAT and CSS were similar. CSS and ISAT provide similar results for assessing laparoscopic suturing but assess different aspects of performance. Using simulator metrics and raters' assessments in combination should be considered for a more comprehensive evaluation of laparoscopic knot-tying competency.

OV07 LAPAROSCOPIC HIATAL HERNIA MESH-SUTURE REPAIR

Abstract Aim “A new original laparoscopic operative technique was used to suture paraesophageal hernia (PEH) with the strips of mesh. Material and Methods The Mercilen (MercilenTM) mesh suture was used to close large hiatal hernia. The strips of mesh, instead of normal thread, were applied to close the gap between diaphragm’s crura in 12 patients with hernia defect more than 5 cm. Mesh suture were tighten as a simple laparoscopic intracorporeal knot. The surgical technique and surgical outcomes are presented. Results 12 patients underwent a laparoscopic PEH suturing with Mercilen strips of mesh. We recorded no recurrence or dysphagia at 6 and 12 months follow-up. Conclusions Mesh-sutured repairs of diaphragm’s hernia support the concepts of force distribution and resistance to suture pull through. The new original technique avoids using the sheet of mesh and enables to reduce the amount of dangerous complications connected with mesh and its fixation. Mesh-sutured closures of hiatal hernias seem to be safe and effective in tension closure of large hiatal defects. Further investigations are needed to evaluate the results. Using the mesh suture technique for the closure of large PEH, we protect the cruras from being cutting through. Besides, the mesh stripes and its knots produce tissue scarring around the esophagus making the suture line stronger.

Laparoscopic mesh-suture hiatal hernia repair

BACKGROUND: A new original laparoscopic operative technique was used to suture paraesophageal hernia (PEH) with the strips of mesh. METHODS: The Mercilen (MercilenTM) mesh suture was used to close large hiatal hernia. The strips of mesh, instead of normal thread, were applied to close the gap between diaphragm's crura in four patients with hernia defect more than 5 cm. Mesh suture were tighten as a simple laparoscopic intracorporeal knot. The surgical technique and surgical outcomes are presented. RESULTS: Four patients underwent a laparoscopic PEH suturing with Mercilen strips of mesh. We recorded no recurrence or dysphagia at 6 and 12 months follow-up. CONCLUSIONS: Mesh-sutured repairs of diaphragm's hernia support the concepts of force distribution and resistance to suture pull through. The new original technique avoids using the sheet of mesh and enables to reduce the amount of dangerous complications connected with mesh and its fixation. Mesh-sutured closures of hiatal hernias seem to be safe and effective in tension closure of large hiatal defects. Further investigations are needed to evaluate the results.

X Marks the Knot: Simplified Laparoscopic Intra-Corporeal Knot Tying

Video Objective The objectives of this video are to present a novel technique for simplified laparoscopic intra-corporeal knot tying and to demonstrate the importance of laparoscopic simulation in learning new techniques. Setting Traditional intra-corporeal knot tying can be difficult, depending on the angle of the suture, port placement, or other technical difficulty. Many surgeons have turned to alternatives to circumvent this procedure, including the use of barbed suture, knotless suture re-load devices, Lapra-ty's, and extra-corporeal knot tying. However, this remains an important skill to for the gynecologic surgeon. This video presents a step-by-step technique of a novel intra-corporeal knot tying method. The setting includes both a simulation trainer for laparoscopy and a live surgery. The patient in the surgery is a 48-year-old female with abnormal uterine bleeding undergoing total laparoscopic hysterectomy; we use our laparoscopic knot to reinforce the vaginal cuff closure. Interventions The simplified extra-corporeal knot starts with placement of an interrupted suture. The primary surgeon crosses the suture to create an X, which is stabilized by the assistant surgeon. The primary surgeon passes the tail of the suture through the loop created by the X twice to create a surgeon's knot. The ends are then pulled downward to create a flat knot. This process is repeated. In order to create square knots, the tail should be passed in front of or behind the loop with each alternating throw. Conclusion The simplified intra-corporal knot is a useful resource for surgeons who experience difficulty with traditional laparoscopic knot tying. The maneuvers are intuitive and are similar to open two-handed knot tying. There is a learning curve associated with this procedure, and it is important to practice in a simulated setting. We hope this video will provide an alternative method for surgeons planning to tie intra-corporeal knots.

1586 Laparoscopic Suturing and Knot Tying

Video Objective Although reliable knot tying is a one of the most important surgical concepts, few videos exist that illustrate how to tie a reproducible, reliable laparoscopic knot. The purpose of this video is to teach the basics of laparoscopic suturing, as well as to illustrate a reproducible method of tying reliable laparoscopic knots. Setting The video setting uses a 3-D Med laparoscopic trainer box with both standard suture and thick, color-blocked string for better demonstration. Interventions N/A Conclusion Laparoscopic suturing and intracorporeal laparoscopic knot tying is one of the most difficult, yet important, skills to learn as a beginning minimally-invasive surgeon. There are few accessible videos which teach how to correctly insert a needle, suture, and tie a reliable knot using laparoscopic tools. This video aims to teach the basics of laparoscopic suturing with the aid of color-blocked string to aid in the viewer's understanding of how to tie a proper knot.

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.

To assess whether the monomanual or bimanual training of laparoscopic suture following the same technique may interfere with the knots' performance time and/or quality. 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. 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. 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.

A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying

BackgroundTraining of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1–G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test (T1) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again (T2) in the same manner than at T1. In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again (T3) in the same manner than at T1 and T2. At each repetition, scoring was based on the time taken for task completion system.ResultsThe scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points (Y0), the point after HEC training/before LICK training (Y1), the Plateau, and the rate constants (K) were calculated. All groups, except for G4, started from a similar point (Y0). At Y1, G5 scored already better than the others (G1 p = .004; G2 p = .04; G3 p < .0001; G4 NS). Although all groups reached a similar Plateau, G5 has a quicker learning than the others, demonstrated by a higher K (G1 p < 0.0001; G2 p < 0.0001; G3 p < 0.0001; and G4 p < 0.0001).ConclusionsOur data confirms that training improves laparoscopic skills and demonstrates that pre-training of all basic skills (i.e., LCN, HEC, and BMC) shortens the LICK learning curve.

Dominant hand, non-dominant hand, or both? The effect of pre-training in hand-eye coordination upon the learning curve of laparoscopic intra-corporeal knot tying

BackgroundTraining of basic laparoscopic psychomotor skills improves both acquisition and retention of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial (RCT) was performed to evaluate the effect of different pre-training programs in hand-eye coordination (HEC) upon the learning curve of LICK.ResultsThe study was performed in a private center in Asunción, Paraguay, by 60 residents/specialists in gynaecology with no experience in laparoscopic surgery. Participants were allocated in three groups. In phase 1, a baseline test was performed (T1, three repetitions). In phase 2, participants underwent different training programs for HEC (60 repetitions): G1 with both the dominant hand (DH) and the non-dominant hand (NDH), G2 with the DH only, G3 none. In phase 3, a post HEC/pre LICK training test was performed (T2, three repetitions). In phase 4, participants underwent a standardized training program for LICK (60 repetitions). In phase 5, a final test was performed (T3, three repetitions). The score was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). For both HEC and LICK, the group learning curves fitted better to the two-phase exponential decay model. For HEC with the DH, G1 and G2 started from a similar point, but G1 reached a lower plateau at a higher speed. In G1, the DH curve started from a lower point than the NDH curve, but both curves reached a similar plateau at comparable speeds. For LICK, all groups started from a similar point, but immediately after HEC training and before LICK training, G1 scored better than the others. All groups reached a similar plateau but with a different decay, G1 reaching this plateau faster than the others groups.ConclusionsThis study demonstrates that pre-training in HEC with both the DH and the NDH shortens the LICK learning curve.

Retention of laparoscopic psychomotor skills after a structured training program depends on the quality of the training and on the complexity of the task.

This follow-up RCT was conducted to evaluate laparoscopic psychomotor skills retention after finishing a structured training program. In a first study, 80 gynecologists were randomly allocated to four groups to follow different training programs for hand-eye coordination (task 1) with the dominant hand (task 1-a) and the non-dominant hand (task 1-b) and laparoscopic intra-corporeal knot tying (task 2) in the Laparoscopic Skills Testing and Training (LASTT) model. First, baseline skills were tested (T1). Then, participants trained task 1 (G1: 1-a and 1-b, G2: 1-a only, G3 and G4: none) and then task 2 (all groups but G4). After training all groups were tested again to evaluate skills acquisition (T2). For this study, 2 years after a resting period, 73 participants were recruited and tested again to evaluate skills retention (T3). All groups had comparable skills at T1 for all tasks. At T2, G1, G2, and G3 improved their skills, but the level of improvement was different (G1 = G2 > G3 > G4 for task 1; G1 = G2 = G3 > G4 for task 2). At T3, all groups retained their task 1 skills at the same level than at T2. For task 2, however, a skill decay was already noticed for G2 and G3, being G1 the only group that retained their skills at the post-training level. Training improves laparoscopic skills, which can be retained over time depending on the comprehensiveness of the training program and on the complexity of the task. For high complexity tasks, full training is advisable for both skills acquisition and retention.

腹腔鏡下に作成する結紮の工夫：slip knot 内無双

To enhance one's skills in laparoscopic surgery, it is essential to learn and master the technique for tying laparoscopic knots. A knot that is made laparoscopically tends to loosen, and the loosened knot is known as an air knot. Once an air knot is formed, it is difficult to untie and then to re-tie it appropriately. The slip knot is an alternative and useful knot to prevent the formation of air knots. We present a newly developed knot tying technique, termed as the Uchimuso slip knot technique. The Uchimuso slip knot technique consists of two throws. The formation of the first single wrap throw is similar to that of the conventional instrument tie technique. The second throw is crucial to forming the new slip knot. This second single wrap throw is formed via a sequential movement by simulating a winning technique in sumo wrestling, known as Uchimuso. The Uchimuso slip knot is easy to learn and master, particularly in the case of laparoscopic intracorporeal knot tying.

Use of Unidirectional Barbed Suture in Gynecologic Laparoscopic Surgery

With the developments in technology, lots of innovations were brought into the use of medical society. Suture material including barb technology (V-Lock) is one of them and it is important for doctors who have limited experience in laparoscopic intracorporeal knot tying. In this article; the advantages and disadvantages of this useful absorbable suture material and its utilization in laparoscopic operations will be mentioned.

Laparoscopic Intracorporeal Cinch Knots: Changing the Square Knot Paradigm

Reliable knot tying is a cornerstone of surgical technique, and the square knot and surgeon’s knot constitute the greatest part of most surgeons’ knot-tying skills. Traditionally, laparoscopic intracorporeal knot tying of a square knot or surgeon’s knot is a direct translation from an open instrument tying technique. Given the technical and mechanical challenges imposed by standard laparoscopic instrumentation, performance of such a basic task is sometimes difficult and elusive, even for accomplished surgeons. Consequently, myriad technologies and techniques are used as work-arounds for this basic surgical task. However, the sometimes necessary tying of a snug and reliable intracorporeal knot is unavoidable. That laparoscopic intracorporeal knot tying must be translated from a 2-handed open surgical technique using flat knots deserves reassessment. Cinch knots, with unusual sliding and tightening properties, are currently used in surgery. With apparent complexity and exacting construction requirements, however, primary intracorporeal knot tying has not been described. Described herein is a technique for doing so. Also included is a review of cinch knot mechanics, an understanding of a fundamental scheme for their construction, and basic instrument maneuvers that enable easier intracorporeal tying of a most reliable knot, useful for multiport and, in particular, single-port laparoscopic knot tying.

Laparoscopic intracorporeal knot tying using a novel device

Laparoscopic intracorporeal knot tying has traditionally been considered the most difficult skill in laparoscopic surgery. We developed a novel device for assisting laparoscopic intracorporeal knotting that transforms a pre-tied slip knot into a secure double sheet bend. The aim of this study is to check the feasibility of using this novel device to assist in performing laparoscopic knot tying. We used a laparoscopic trainer with a piece of plastic artificial skin as an experimental model. Twenty laparoscopic device-assisted double sheet bends (experimental group) and 20 traditional laparoscopic two-turn flat square knots (control group) were performed in random order. After cutting the loop and the ends of each knot, all 40 knotted threads and an additional eight unknotted threads were transferred to a tensiometer to test their strength using the single-strand method. Post-knotting variables of the two groups were compared. Knot strength (mean ± standard deviation) did not differ between the two groups (experimental group: 2.26 ± 0.50 kg vs. control group: 2.03 ± 0.94 kg; P = 0.51). The knot efficiencies of the experimental and control group were 60.6 and 54.4% (P = 0.51), respectively. However, the experimental group had a lower knot failure rate (5 vs. 40%, P = 0.02) and shorter knotting time (37.0 ± 9.2 vs. 107.0 ± 47.7 s, P < 0.001) compared with the control group. This novel device significantly shortened the knotting time of laparoscopic intracorporeal knot tying, and did not compromise the success rate or strength of the knot.

Suturing in Parallel and Perpendicular Planes: A Systematic and Geometric Approach to Laparoscopic Suturing and Intracorporeal Knot Tying

Suturing in Parallel and Perpendicular Planes: A Systematic and Geometric Approach to Laparoscopic Suturing and Intracorporeal Knot Tying

Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator

The effect of different structured training programs on basic laparoscopic psychomotor skills (LPS), as assessed by hand–eye coordination (HEC), and on advanced LPS, as assessed by laparoscopic intracorporeal knot tying (LICK), was evaluated. Sixty gynecologists without laparoscopic experience were randomly allocated to three groups for different HEC training and similar LICK training. During HEC training, group 1 (G1) trained the dominant hand (DH) and the nondominant hand, G2 trained the DH only, and G3 did not train at all. All groups then underwent LICK training. HEC and LICK training consisted of 60 repetitions of the relevant task. All participants were tested at the beginning of the study (T1), before LICK training (T2), and after LICK training (T3). The time to correctly performed exercise was scored. The groups had comparable scores at T1. At T2, G1 and G2 improved their relevant HEC scores (both hands in G1, DH in G2), and LICK scores improved according to the previous HEC training (G1 > G2 or G3 and G2 > G3). At T3, all groups further improved their LICK scores up to the same level. The LICK training did not provide any additional improvement in HEC for G1 and G2, but it further improved HEC for G3, though not up to the same level of the other groups. This study confirms that training improves laparoscopic skills and indicates that many repetitions are required for reaching proficiency. Full acquisition of LPS (e.g., HEC) facilitates the acquisition of more complex laparoscopic tasks (e.g., LICK). Mastering LICK is not sufficient for acquiring HEC skills, the clinical relevance of which still needs to be evaluated. Mastering both skills before starting a training program in the operating theater is advisable.

Comparison of Text versus Video for Teaching Laparoscopic Knot Tying in the Novice Surgeon: A Randomized, Controlled Trial

Background Video seems advantageous over traditional text as an educational tool in conceptually-based procedures such as laparoscopy. However, this has never been tested directly. Objective The purpose of this study was to compare the use of text versus video as an educational tool for laparoscopic training, through a randomized controlled trial. Study Design Prospective, randomized, controlled clinical trial (Canadian Task Force classification I). Methods Eighty (n = 80) medical students, who had no experience with tying a laparoscopic intracorporeal knot, were randomly taught to do so by either reading a text with accompanying pictures (n = 40) or watching a short video with audio of comparable content (n = 40). The participants were allowed to review the material for as long as they needed to achieve understanding of the procedure. They were then asked to tie a laparoscopic square knot in a box trainer, with a limit time of 15 minutes. Time to review the educational material(s), time to tie the knot(s), numbers of attempts at the task (n), and numbers of those who expressed understanding of the task (n) were recorded. Results The number of participants who were able to complete the knot (n = 14 text v. n = 18 video, p = 0.49) and the average time needed for completion (479 s text v.494 s video, p = 0.38) were not statistically different in the two groups. However, time to review the material (407 s text v. 258 s video, p < 0.001), number of attempts at the task (15 text v. 5 video had n>2 attempts, p = 0.01), and number of those who expressed understanding when they could not complete the task (35% text v. 59% video, p = 0.047) were statistically different. Conclusions This is the first randomized trial evaluating video alone as an educational tool in laparoscopic training. It demonstrates that video is superior to text in achieving superior conceptual understanding, without improving operative times. Understanding through video instruction cannot make up for a lack of technical ability in novice surgeons.

A New Technique for Intracorporeal Knot Tying in Laparoscopic Surgery

Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is a difficult process with a long learning curve. Intracorporeal suturing is essential to advanced laparoscopy and is a rate-limiting step in many procedures. Many different instruments and methods have been described for laparoscopic suturing and knot tying. We have developed a new technique for laparoscopic knot tying. The long end of the suture is held with a left-hand instrument, and the instrument is rotated for 360 degrees in a clockwise direction to make a forward-direction loop. The end of the loop is grasped with the right-hand instrument, and the other end of the suture is grasped with the left-hand instrument. The suture end, held by the left hand, is pulled though the loop and tied, thus making a half-knot of a square knot. The second half-knot is made by using the right-hand instrument with the same technique. Laparoscopic suturing and knotting is difficult to perform, especially when the angle between the working instruments is narrow and working space is limited. In all these situations, knot tying using this technique makes knotting more simple and easy to perform, especially for those who have limited experience in intracorporeal suturing and knot tying. No special instrument is required to perform knot tying with this technique.

Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality

Background Very few studies have addressed the transferability of skills from virtual reality (VR) to real life. The aim of this study was to assess the feasibility and effectiveness of teaching intracorporeal knot tying (ICKT) by VR simulation only. Methods Twenty novices underwent structured training of basic skills training on the Minimally Invasive Surgical Trainer simulator (Mentice AB, Gothenburg, Sweden) followed by knot tying training on the LapSim simulator (Surgical Science, Gothenburg, Sweden). They were assessed pre- and post-training on a video trainer. Assessment of performance included motion tracking and video-based checklist. Nonparametric statistical analysis was used, and P < .05 was deemed significant. Results All participants completed a correct knot as compared with only 25% before VR training. Time to completion was 66% faster and knot quality 45% better after VR training. Significant reduction in number of movements ( P = .006) and distance traveled ( P < .000) by both hands after VR training. Conclusions Teaching ICKT by VR simulators only is feasible and effective. Furthermore, this study highlights the complementary use of different VR simulators within a structured curriculum.

Evaluation of a Novel Modified Suture Material Designed to Facilitate Intracorporeal Knot Tying during Laparoscopic Surgery

Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is an arduous process with a long learning curve. While recent advances in instrumentation have allowed easier suturing and tying, until now, no attempts have been made to modify the suture material in order to facilitate this process. We present an evaluation of a novel modified suture material designed to allow inexperienced surgical residents to tie intracorporeal knots laparoscopically using conventional laparoscopic needle drivers. Surgical residents with no prior experience in laparoscopic surgery were invited to take part in this investigation. Each of the 14 participants was given a 10-minute demonstration of laparoscopic intracorporeal knot tying and then allowed a mentored practice session of 10 minutes. In the first trial, they were then randomized to tie a laparoscopic knot with either a standard or a modified dry suture. Time and accuracy scores were recorded. They then performed the same task with the other type of suture. On the second trial, wet standard and modified sutures were used, and the order of the sutures used in the first trial was reversed. The average time taken to tie an intracorporeal knot laparoscopically was significantly less when the modified suture was used in both dry and wet conditions (162.71 +/- 10.79 seconds v 270.86 +/- 22.76 seconds; P = 0.0039, and 123.29 +/- 4.70 seconds v 247.57 +/- 23.17 seconds; P = 0.0032, respectively). No significant difference in accuracy scores was noted with the two sutures. Our modified suture design allowed inexperienced surgical residents to perform intracorporeal laparoscopic knot tying on average faster than the standard suture did. The concept of modifying suture design to facilitate laparoscopic suturing and knot tying deserves further investigation and development.