Feedback based simulator training reduces superfluous forces exerted by novice residents practicing knot tying for vessel ligation

Technological advances have led to the development of state-of-the-art simulators for training surgeons; few train basic surgical skills, such as vessel ligation. A novel low-cost bench-top simulator with auditory and visual feedback that measures forces exerted during knot tying was tested on 14 surgical residents. Pre- and post-training values for total force exerted during knot tying, maximum pulling and pushing forces and completion time were compared. Mean time to reach proficiency during training was 11:26 min, with a mean of 15 consecutive knots. Mean total applied force for each knot were 35% lower post-training than pre-training (7.5 vs. 11.54 N (N), respectively, p = 0.039). Mean upward peak force was significantly lower after, compared to before, training (1.29 vs. 2.12 N, respectively, p = 0.004). Simulator training with visual and auditory force feedback improves knot-tying skills of novice surgeons. [Display omitted] •We developed a simulator for knot tying that incorporates a force feedback feature.•Novice residents applied 35% less force after simulation training.•A short period of practice is needed to avoid excessive use of force.•Residents achieved the same competence as experienced surgeons.•Basic surgical skill simulators can objectively evaluate and hone performance.