Board 549- Technology Innovations Abstract A New Objective Assessment System of the Suture Ligature Method of the Intestinal Anastomosis Model for Laparoscopic Surgery (Submission #856)

Introduction/Background Various training simulators for laparoscopic surgery skills have been developed, such as virtual reality simulators and box trainers. Surgical skills are typically evaluated by measuring the path lengths of the tips of the operative instruments using three-dimensional tracking sensors. Experienced surgeons are generally able to perform tasks with shorter path lengths and time than inexperienced operators.1,2 However, there is no method of assessing laparoscopic surgery skills designed to specifically assess the suture ligature method, which provides a quantitative result based on the clinical condition. The purpose of this study was to develop a new objective assessment system of the suture ligature method of the intestinal anastomosis model for laparoscopic surgery. In this study, we evaluated objective suturing skill using this system. Methods Materials & Methods: Sixteen doctors who had each performed over 100 laparoscopic surgeries (expert group) and 23 medical students who had no experience of laparoscopic surgery (novice group) were enrolled in this study. The novice group practiced a suturing method to successfully perform three suture ligatures before this experiment. The new assessment system consists of a new artificial intestinal model, which has an intestine-like structure, and a pressure measurement device. The artificial intestinal model consists of four layers, including the mucosal layer, submucosal layer, muscle layer, and serosal layer. Suturing skill was evaluated by internal air pressure of the model. The model has a ten mm size wound at the center. The examinees performed a suturing task using the artificial model with a box trainer. We compared the number of stitches, the performance time, and the internal air pressure between both groups, and examined the similarity of the model to the intestine by a questionnaire given to only the expert group because the novice group had no clinical experience. We analyzed the data and evaluated acceptable values for the skill assessment task in this system. Results for the expert and novice groups were compared using the Student’s t-test. A p value <0.05 was defined as statistically significant. Results: Table 1 shows the Results of the comparisons between the expert group and the novice group. The similarity of the model to the intestine was 71.9%. The appropriate values of the number of stitches, the performance time, and the internal air pressure were three stitches, 417 s, and 5.20 [kPa], respectively, because maximum differences were found between the expert group and novice group under the condition of three stiches. Table 1 Comparison of Results between the expert and novice groups Results: Conclusion Our objective system is useful for assessing suturing skill in laparoscopic surgery in a quantitative manner. References 1. Verdaasdonk EGG, Dankelman J, Lange JF, Stassen LPS. Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial. Surgical endoscopy. 2008;22(7):1636-42. 2. Hofstad EF, Våpenstad C, Chmarra MK, Langø T, Kuhry E, Mårvik R. A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance. Surgical endoscopy. 2013;27(3):854-63. Disclosures None.