A low-cost balloon-based simulator for teaching surgical knot techniques to veterinary students

The acquisition of surgical skills is an essential component of veterinary training. The use of live animals or cadavers for early surgical skills development is limited by ethical, logistical and financial constraints, highlighting the need for accessible and animal welfare-oriented training alternatives. The objective of this study was to evaluate the effectiveness of a low-cost, balloon-based simulator for teaching basic surgical knot techniques to undergraduate veterinary students with no prior surgical experience. A cohort of 20 students practised slip knots, Miller's knots and transfixation knots, using a low-fidelity balloon simulator under a structured training protocol. Performance was assessed by using standardised rubrics, i.e. execution time and a binary success/failure classification based on air leakage. From the 13th repetition onward, all students successfully executed slip knots and Miller's knots, while competency in the transfixation knot was achieved by the 14th repetition. Execution time decreased significantly from the 11th repetition for all three techniques, indicating progressive improvement in technical efficiency. It was evident that the balloon-based simulator facilitated the acquisition of basic surgical knot-tying skills, and represents an accessible, ethical and effective tool for early-stage surgical training in veterinary education.