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. 2022 Apr;32(4):1201-1208.
doi: 10.1007/s11695-022-05918-z. Epub 2022 Feb 24.

Laparoscopic Small Bowel Length Measurement in Bariatric Surgery Using a Hand-Over-Hand Technique with Marked Graspers: an Ex Vivo Experiment

Nienke Slagter  1   2 , Mette van Wilsum  3 , Loek J M de Heide  3 , Ewoud H Jutte  3 , Mirjam A Kaijser  3 , Stefan L Damen  3 , André P van Beek  4 , Marloes Emous  3
Affiliations

Laparoscopic Small Bowel Length Measurement in Bariatric Surgery Using a Hand-Over-Hand Technique with Marked Graspers: an Ex Vivo Experiment

Nienke Slagter et al. Obes Surg. 2022 Apr.

Abstract

Introduction: Tailoring limb length in bariatric surgery is a subject of many studies. To acquire the optimal limb length, accurate measurement of the small bowel length is essential.

Objective: To assess the intra- and inter-individual variability of laparoscopic bowel length measurement using a hand-over-hand technique with marked graspers.

Method: Four bariatric surgeons and four surgical residents performed measurements on cadaver porcine intestine in a laparoscopic box using marked graspers. Each participant performed 10 times a measurement of three different lengths: 150, 180, and 210 cm. Acceptable percentage deviation from the goal lengths was defined as less than 10%, while unacceptable deviations were defined as more than 15%.

Results: The bariatric surgeons measured the 150-, 180-, and 210-cm tasks with 4% (CI 0.4, 9), - 6% (CI - 11, - 0.8), and 1% (CI - 4, 6) deviation, respectively. In total, the bariatric surgeons estimated 58 out of 119 times (49%) between the margins of 10% deviation and 36 times (30%) outside the 15% margin. Considerable inter-individual differences were found between the surgeons. The surgical residents underestimated the tasks with 12% (CI - 18, - 6), 16% (CI - 19, - 13), and 18% (CI - 22, - 13), respectively.

Conclusion: Bariatric surgeons estimated bowel length with on average less than 10% deviation. However, this still resulted in 30% of the measurements with more than 15% deviation. There were considerable inter-individual differences between the surgeons and residents structurally underestimated the bowel length. Ascertainment of measurement accuracy and adequate training is essential for bariatric procedures in which limb length is of importance.

Keywords: Bariatric surgery; Laparoscopic bowel length measurement; Limb length; Small bowel length.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Laparoscopic set up. A Laparoscopic box trainer B small bowel of the porcine
Fig. 2
Fig. 2
The acceptable cut-off value of 10% and the unacceptable cut-off point of 15% for the different measured limb lengths
Fig. 3
Fig. 3
Percentage deviation on all three tasks measured by the bariatric surgeons
See this image and copyright information in PMC

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