Skip to main content

Advertisement

SpringerLink
Log in

Objective assessment of the suture ligature method for the laparoscopic intestinal anastomosis model using a new computerized system

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to develop a new objective assessment system for the suture ligature method employed in the laparoscopic intestinal anastomosis model. Suturing skills were evaluated objectively using this system.

Methods

This study compared 17 expert surgeons, each of whom had performed >500 laparoscopic procedures, with 36 novice surgeons, each of whom had performed <15 laparoscopic procedures. Each examinee performed a specific skill assessment task using an artificial model that mimics living tissue, which is linked with the Suture Simulator Instruction Evaluation Unit. The model used internal air pressure measurements and image processing to evaluate suturing skills. Five criteria were used to evaluate the skills of participants.

Results

The volumes of air pressure leak in the expert and novice groups were 21.13 ± 6.68 and 8.51 ± 8.60 kPa, respectively. The numbers of full-thickness sutures in the expert and novice groups were 2.94 ± 0.24 pairs and 2.47 ± 0.77 pairs, respectively. Suture tensions in the expert and novice groups were 60.99 ± 11.81 and 80.90 ± 16.63 %, respectively. The areas of wound-opening in the expert and novice groups were 1.76 ± 2.17 and 11.06 ± 15.37 mm2, respectively. The performance times in the expert and novice groups were 349 ± 120 and 750 ± 269 s, respectively. Significant differences between the expert and novice groups for each criterion were observed. The acceptable range of values for each criterion except for the number of full-thickness sutures was statistically defined by the performance of the expert group.

Conclusions

Our system is useful for the quantitative assessment of suturing skill in laparoscopic surgery. We believe that this system is a useful tool for training and assessment of laparoscopic surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Verdaasdonk EGG, Dankelman J, Lange JF, Stassen LPS (2008) Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial. Surg Endosc 22:1636–1642

    Article  CAS  PubMed  Google Scholar 

  2. Hofstad EF, Våpenstad C, Chmarra MK et al (2013) A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance. Surg Endosc 27:854–863

    Article  PubMed  Google Scholar 

  3. Uemura M, Tomikawa M, Nagao Y et al (2014) Significance of metacognitive skills in laparoscopic surgery assessed by essential task simulation. Minim Invasive Ther Allied Technol 23:165–72

  4. Uemura M, Tomikawa M, Kumashiro R et al (2014) Analysis of hand motion differentiates expert and novice surgeons. J Surg Res 188:8–13

    Article  PubMed  Google Scholar 

  5. Tanoue K, Ieiri S, Konishi K et al (2008) Effectiveness of endoscopic surgery training for medical students using a virtual reality simulator versus a box trainer: a randomized controlled trial. Surg Endosc 22:985–990

    Article  CAS  PubMed  Google Scholar 

  6. Ieiri S, Nakatsuji T, Higashi M et al (2010) Effectiveness of basic endoscopic surgical skill training for pediatric surgeons. Pediatr Surg Int 26:947–954

    Article  PubMed  Google Scholar 

  7. Ieiri S, Ishii H, Souzaki R et al (2013) Development of an objective endoscopic surgical skill assessment system for pediatric surgeons: suture ligature model of the crura of the diaphragm in infant fundoplication. Pediatr Surg Int. doi:10.1007/s00383-013-3276-x

    PubMed  Google Scholar 

  8. Uemura M, Tomikawa M, Kumashiro R et al (2014) Analysis of hand motion differentiates expert and novice surgeons. J Surg Res 188:8–13

  9. Yamaguchi S, Yoshida D, Kenmotsu H et al (2011) Objective assessment of laparoscopic suturing skills using a motion-tracking system. Surg Endosc 25:771–775

    Article  PubMed  Google Scholar 

  10. Aggarwal R, Grantcharov TP, Eriksen JR et al (2006) An evidence-based virtual reality training program for novice laparoscopic surgeons. Ann Surg 244:310–314

    Article  PubMed Central  PubMed  Google Scholar 

  11. Wilson M, McGrath J, Vine S et al (2010) Psychomotor control in a virtual laparoscopic surgery training environment: gaze control parameters differentiate novices from experts. Surg Endosc 24:2458–2464

    Article  PubMed Central  PubMed  Google Scholar 

  12. Bell AK, Zhou M, Schwaitzberg SD, Cao CGL (2009) Using a dynamic training environment to acquire laparoscopic surgery skill. Surg Endosc 23:2356–2363

    Article  CAS  PubMed  Google Scholar 

  13. Lauretta A, Bellomo RE, Galanti F, Tonizzo CA, Infantino A (2012) Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results. Tech Coloproctol 16:477–483

    Article  CAS  PubMed  Google Scholar 

  14. Hemming K, Pinkney T, Futaba K et al (2013) A systematic review of systematic reviews and panoramic meta-analysis: staples versus sutures for surgical procedures. PLoS ONE 8:e75132

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Fumagalli Romario U, Ceolin M, Porta M, Rosati R (2012) Laparoscopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg 24:213–217

    Article  PubMed  Google Scholar 

  16. Zimmitti G, Vauthey J-N, Shindoh J et al (2013) Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications. J Am Coll Surg 217:1028–1037

    Article  PubMed  Google Scholar 

  17. Dehabadi M, Fernando B, Berlingieri P (2014) The use of simulation in the acquisition of laparoscopic suturing skills. Int J Surg 12:258–268

    Article  PubMed  Google Scholar 

  18. Botden SMBI, de Hingh IHJT, Jakimowicz JJ (2009) Suturing training in augmented reality: gaining proficiency in suturing skills faster. Surg Endosc 23:2131–2137

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Horeman T, Blikkendaal MD, Feng D et al (2014) Visual force feedback improves knot-tying security. J Surg Educ 71:133–141

    Article  PubMed  Google Scholar 

  20. Morse BC, Simpson JP, Jones YR et al (2013) Determination of independent predictive factors for anastomotic leak: analysis of 682 intestinal anastomoses. Am J Surg 206:950–955 (discussion 955–956)

    Article  PubMed  Google Scholar 

  21. Cui Y, Chen H (2003) The effect of tension on esophagogastric anastomotic wound healing in rats. J Cardiovasc Surg (Torino) 44:775–778

    CAS  Google Scholar 

  22. Waninger J, Kauffmann GW, Shah IA, Farthmann EH (1992) Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses. Am J Surg 163:319–323

    Article  CAS  PubMed  Google Scholar 

  23. Oguma J, Ozawa S, Morikawa Y et al (2007) Knot-tying force during suturing and wound healing in the gastrointestinal tract. J Surg Res 140:129–134

    Article  PubMed  Google Scholar 

  24. Forestier G, Lalys F, Riffaud L, Trelhu B, Jannin P (2012) Classification of surgical processes using dynamic time warping. J Biomed Inform 45:255–264

    Article  PubMed  Google Scholar 

  25. Neumuth T, Jannin P, Strauss G, Meixensberger J, Burgert O (2009) Validation of knowledge acquisition for surgical process models. J Am Med Inform Assoc 16:72–80

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Disclosures

Drs. Uemura, Yamashita, Tomikawa, Obata, Souzaki, Ieiri, Ohuchida, Matsuoka, Katayama, and Hashizume have no conflict of interests or financial ties to disclose.

Author information

Authors and Affiliations

  1. Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan

    Munenori Uemura, Kenoki Ohuchida & Makoto Hashizume

  2. Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Makoto Yamashita, Morimasa Tomikawa, Satoshi Obata, Ryota Souzaki, Satoshi Ieiri & Makoto Hashizume

  3. Kyoto Kagaku Co., Ltd, Kyoto, Japan

    Noriyuki Matsuoka & Tamotsu Katayama

Authors
  1. Munenori Uemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Makoto Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Morimasa Tomikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoshi Obata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryota Souzaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Satoshi Ieiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kenoki Ohuchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Noriyuki Matsuoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tamotsu Katayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Makoto Hashizume
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Makoto Hashizume.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uemura, M., Yamashita, M., Tomikawa, M. et al. Objective assessment of the suture ligature method for the laparoscopic intestinal anastomosis model using a new computerized system. Surg Endosc 29, 444–452 (2015). https://doi.org/10.1007/s00464-014-3681-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3681-9

Keywords

Search

Navigation