An Inanimate Intracorporeal Anastomosis Model With Real-Time Force Feedback: An Initial Study

Laparoscopic intestinal anastomosis requires specific technical skills and should be trained in a safe simulation environment before performing surgery in daily practice. However, anastomosis simulation training with objective feedback is not widely available. This study aimed to analyze a laparoscopic intestinal anastomosis training task that utilizes objective force, motion, and time measurements.

With the feedback of laparoscopic experts, an artificial tissue reproducible intestinal anastomosis training task was designed and developed. Novices and experts performed the training task four times using two running suture techniques, with a multifilament braided suture and a barbed suture. The laparoscopic box trainer (Lapron box trainer, Amsterdam Skills Centre, Amsterdam, the Netherlands) provided objective force, motion, and time feedback. The mean values of the parameters were calculated and analyzed using the Mann-Whitney U test.

A total of 212 intestinal anastomosis repetitions were performed by 35 novices and 18 experts from 14 European teaching hospitals. For the multifilament braided sutures, experts showed significant lower maximal impulses (19.80 versus 12.90 Ns, P = 0.004), shorter total path length (23,545 mm versus 15,266 mm, P ≤ 0.001) and required less time to finish the task compared to novices (448 s versus 297 s, P ≤ 0.001). Using the barbed sutures, experts used significantly lower maximal forces (2.93 N versus 2.31 N, P = 0.032), had a shorter total path length (13,608 mm versus 8551 mm, P ≤ 0.001), and needed less time to execute the training task compared to novices (253 s versus 166 s, P ≤ 0.001).

The development of a modular and reproducible laparoscopic intestinal anastomosis training task with established construct validity for force, motion, and time-based assessment of technical skills allows for repetitive training of advanced skills. These outcomes can now be utilized to assess translation of these skills into the operating room.