A single in-person training session using a laparoscopic video trainer is insufficient for teaching the construction of 4S-modified Roeder slip knots

Objective: To determine if a single training session suffices for teaching novices construction of the 4S-modified Roeder (4SModR) slip knot. Methods: From June through August 2022, Doctor of Veterinary Medicine candidates received written and video-based tutorials prior to a single in-person training session performed by a Doctor of Veterinary Medicine candidate with extensive training but without laparoscopic surgical experience (intermediate). Knots were tied before and after a single training session using a laparoscopic video trainer, and instruction proceeded until each participant correctly tied 4 consecutive knots. Novice and intermediate tied knots underwent biomechanical testing. Training time and common errors were documented. The 2 most common knot-tying errors were reproduced by the intermediate tyer and biomechanically tested. Results: Post-training novice-tied 4SModR knots were significantly stronger than the pretraining knots in both loop holding strength and load at failure. The failure load, but not the loop holding strength, of post-training knots was lower than the intermediate tyer's knot constructs. The inability to differentiate the loop end and the post end resulted in significantly weaker knots, with 9 of 12 knots with that error recreated failing at less than 7 N before load. Conclusions: A short training session results in weaker knots when compared to knots tied by a more experienced tyer. Clinical Relevance: Substantial training time is required to learn and produce a strong 4SModR knot. Adequate time to learn, practice, and perform these knots should be allocated for surgery trainees.