A simulator for measuring forces during surgical knots

Shlomi Laufer*, Imri Amiel, Jay N. Nathwani, Roy Mashiach, Ruth S. Margalit, Rebeca D. Ray, Amitai Ziv, Carla M. Pugh

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review


In this study new metrics were developed for assessing the performance of surgical knots. By adding sensors to a knot tying simulator we were able to measure the forces used while performing this basic and essential skill. Data were collected for both superficial tying and deep tying of square knots using the one hand and two hands techniques. Participants used significantly more force when tying a deep knot compared to a superficial knot (3.79N and 1.6N respectively). Different patterns for upward and downward forces were identified and showed that although most of the time upward forces are used (72% of the time), the downward forces are just as large. These data can be crucial for improving the safeness of knot tying. Combing these metrics with known metrics based on knot tensiometry and motion data may help provide feedback and objective assessment of knot tying skills.

Original languageEnglish
Title of host publicationMedicine Meets Virtual Reality 22, NextMed/MMVR 22
EditorsLi Fellander-Tsai, Kirby G. Vosburgh, James D. Westwood, Steven Senger, Susan W. Westwood, Cali M. Fidopiastis, Alan Liu
PublisherIOS Press
Number of pages6
ISBN (Electronic)9781614996248
StatePublished - 2016
Externally publishedYes
EventMedicine Meets Virtual Reality 22, NextMed/MMVR 2016 - Los Angeles, United States
Duration: 7 Apr 20169 Apr 2016

Publication series

NameStudies in Health Technology and Informatics
ISSN (Print)0926-9630
ISSN (Electronic)1879-8365


ConferenceMedicine Meets Virtual Reality 22, NextMed/MMVR 2016
Country/TerritoryUnited States
CityLos Angeles


  • Knot tying
  • Simulators
  • Surgical education
  • Technical skills


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