Journal of Surgical Simulation 2018; 5: 60 - 63

Published: 10 December 2018


Original article

Loop ligation: objective assessment of surgical efficiency in vessel ligation with electromagnetic hand motion analysis

Robert Miller and Georgios Pafitanis
Corresponding author: Georgios Pafitanis, Group for Academic Plastic Surgery, Queen Mary University of London, 4 Newark Street, Whitechapel, London EI 2AT, UK. Email:


Background: Vessel ligation is a common technique within many surgical specialties. We present the loop vessel ligation technique and compare it with the conventional vessel hand-tie technique.

Methods: Two surgeons performed vessel ligations using both loop vessel ligation and the conventional two-suture ligation technique. Hand motion analysis data were collected using the Dextrous MD electromagnetic device. Parameters including total path length (TP), total movements (TM) and total time (TT) were calculated to allow comparison of the techniques. An overall surgical performance (OSP) indicator was generated to reflect the collective effect of all variables.

Results: Twenty vessel ligations were performed using both techniques. TP, TM and TT taken to complete a vessel ligation were all significantly improved with the loop vessel ligation technique (P < 0.0001). The OSP score was significantly better using the loop vessel ligation technique (P < 0.0001).

Conclusion: Using electromagnetic hand motion analysis, this study objectively demonstrates that the loop vessel ligation technique significantly improves surgical performance for vessel ligation.


vessel ligation; hand-tie vessel; loop ligation; surgical efficiency; hand motion analysis