5 research outputs found
Tensile strength of a surgeon’s or a square knot
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Objective—To test the integrity of surgeon’s knots and flat square knots using four different
suture materials.
Study Design—Chromic catgut, polyglactin 910, silk, and polydioxanone sutures were tied in
the two types of knot configurations. For all sutures, a 0-gauge United States Pharmacopeia suture
was used. Knots were tied by a single investigator (JB). Suture was soaked in 0.9 % sodium
chloride for 60 seconds and subsequently transferred to a tensiometer where the tails were cut to 3
mm length. We compared the knots, measuring knot strength using a tensiometer until the sutures
broke or untied.
Results—A total of 119 knots were tied. We found no difference in mean tension at failure
between a surgeon’s knot (79.7 Newtons) and a flat square knot (82.9 Newtons). Using a Chisquare
test, we did not find a statistically significant difference in the likelihood of knots coming
untied between surgeon’s knots (29%) and flat square knots (38%).
Conclusions—Under laboratory conditions, surgeon’s knots and flat square knots did not differ
in tension at failure or likelihood of untying
Hysterectomy Volume Among Recent Obstetrics and Gynecology Residency Graduates
OBJECTIVE: Although guidelines recommend hysterectomy be performed vaginally whenever possible, recent trainees have decreased exposure to vaginal hysterectomy given the availability of laparoscopic hysterectomy, nonsurgical management, and falling volume nationwide. We sought to estimate hysterectomy volume in the 5 years after residency. Our secondary objective was to compare vaginal hysterectomy utilization between recent graduates and senior surgeons.
METHODS: Retrospective, statewide data from 2005 to 2014 was obtained from the Massachusetts Center for Health Information Analysis. All hysterectomies performed in Massachusetts, regardless of payer type, were included. Surgeon identifiers were cross-referenced to another data set with provider demographics. Hysterectomies performed in the first 5 years after graduation were compared with a group 21 to 25 years after residency.
RESULTS: Data from inpatient and outpatient databases revealed 87,846 hysterectomies performed by 1967 physicians, including 3146 simple hysterectomies by 192 recent graduates. Recent graduates chose abdominal hysterectomy (44.2%) most commonly, followed by laparoscopic (29.4%), vaginal (16.1%), and laparoscopically assisted vaginal (10.4%). Recent graduates performed a median of 3 to 4 hysterectomies in each of the first 5 years with no increase over time (P = 1). The median number of vaginal or laparoscopic hysterectomies was 0 in these 5 years (interquartile ranges, 0-1 and 0-2, respectively). Members of the senior cohort performed a median of 8 to 9 hysterectomies annually, completing them vaginally more often (24.7% vs 16.1%, P \u3c 0.01). When controlling for patient age and hysterectomy indication, this effect dissipated.
CONCLUSIONS: Recent graduates perform 3 to 4 (interquartile range, 1-7) hysterectomies annually, predominantly by laparotomy. Although senior surgeons perform vaginal hysterectomy more often, this is explained by patient characteristics