# Objective assessment of cesarean section suturing techniques using a uterine simulator

## TL;DR

This study uses a uterine simulator to compare cesarean section suturing techniques, finding that barbed sutures and specific methods can reduce the impact of surgeon experience on wound quality.

## Contribution

The study introduces a simulation-based method to objectively assess and standardize cesarean suturing techniques.

## Key findings

- Experts using barbed sutures showed higher wound density but greater deformation and larger endometrial openings.
- Novices using barbed sutures achieved wound quality comparable to experts using conventional sutures.
- Layer-to-layer suturing with barbed sutures produced results closer to the ideal wound condition.

## Abstract

Cesarean wound healing is influenced by surgeon experience, suture type, and technique. This study utilized a simulation model to quantify these effects. Obstetricians–gynecologists and junior residents performed two-layer continuous suturing on uterine models, forming eight groups based on experience level (expert, novice), suture type (conventional, barbed), and technique (Albert–Lembert, layer-to-layer). The ideal wound condition was defined as that achieved by an expert using barbed sutures and the layer-to-layer technique. Wound characteristics were quantified and compared to this ideal. Experts using barbed sutures in Albert–Lembert suturing showed higher wound density but greater deformation and larger endometrial openings (both P < 0.01). Novices using barbed sutures in Albert–Lembert suturing showed similar wound density but significantly greater deformation and opening (both P < 0.01). Novices using conventional sutures in layer-to-layer suturing showed the lowest wound density and longest suturing time (both P < 0.01). Notably, novices using barbed sutures achieved wound characteristics comparable to experts using conventional sutures in Albert–Lembert suturing and results closer to the ideal in layer-to-layer suturing. These findings establish a quantifiable standard for cesarean suturing and suggest that optimizing suture types and techniques may help compensate for differences in surgical expertise.

The online version contains supplementary material available at 10.1038/s41598-026-37041-9.