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This study utilized a simulation model to quantify these effects. Obstetricians\u2013gynecologists 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\u2013Lembert, 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\u2013Lembert suturing showed higher wound density but greater deformation and larger endometrial openings (both P\u2009&lt;\u20090.01). Novices using barbed sutures in Albert\u2013Lembert suturing showed similar wound density but significantly greater deformation and opening (both P\u2009&lt;\u20090.01). Novices using conventional sutures in layer-to-layer suturing showed the lowest wound density and longest suturing time (both P\u2009&lt;\u20090.01). Notably, novices using barbed sutures achieved wound characteristics comparable to experts using conventional sutures in Albert\u2013Lembert 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.<\/jats:p>","DOI":"10.1038\/s41598-026-37041-9","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T21:55:27Z","timestamp":1770328527000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Objective assessment of cesarean section suturing techniques using a uterine simulator"],"prefix":"10.1038","volume":"16","author":[{"given":"Hikari","family":"Nakato","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jota","family":"Maki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiaki","family":"Kuriyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shujiro","family":"Sakata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichi","family":"Oishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayano","family":"Suemori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hikaru","family":"Ooba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Mitoma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakazu","family":"Kato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakurako","family":"Mishima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiko","family":"Ohira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoe","family":"Kirino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eriko","family":"Eto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisashi","family":"Masuyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"37041_CR1","unstructured":"Ministry of Health, Labour and Welfare. 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However, free supplies such as the uterine model were provided by Kyoto Kagaku Co., Ltd. In addition, Jota Maki and Hisashi Masuyama have a conflict of interest with Kyoto Kagaku Co., Ltd. during 2023\u20132024, including the provision of free supplies such as the uterine model, model stands, and measurement devices used in this study. Jota Maki was a member of the Speaker\u2019s Bureau for Ethicon, Johnson & Johnson, New Brunswick, NJ, USA from 2022\u00a0to\u00a02024. The remaining authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7456"}}