Munenori Uemura, MMedSci, Makoto Yamashita, Morimasa Tomikawa, MD, PhD, FACS, Satoshi Oabata, MD, Ryota Souzaki, MD, PhD, Satoshi Ieiri, MD, PhD, Kenoki Ohuchida, MD, PhD, Noriyuki Matsuoka, Tamotsu Katayama, Makoto Hashizume, MD, PhD, FACS. Kyushu Univeristy.
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 Figure 1a shows the newly developed, computerized system for objective assessment of the suture ligature method used in the laparoscopic intestinal anastomosis model. The system is fitted with a new artificial intestinal model, which has an intestine-like structure (figure 1b), and pressure measuring and image processing devices. 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 (figure 1c). For each criterion, an acceptable range was defined by minimum and maximum values derived from statistical analysis of the expert surgeons’ performances.
Results The volumes of air pressure leak in the expert and novice groups were 21.13 ± 6.68 kPa 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 mm2 and 11.06 ± 15.37 mm2, respectively. The performance times in the expert and novice groups were 349 ± 120 s 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 was statistically defined by the performance of the expert group. Table 1 shows the results of the acceptable performance range as determined by the performance of the expert group.
Conclusions Our system is useful for quantitative assessment of suturing skill in laparoscopic surgery. We believe that this system is a useful tool for training and assessment of laparoscopic surgeons.
Volume of air pressure leak (kPa)
Number of full-thickness sutures (pairs)
Suture tension (%)
Wound opening area (mm2)
Performance time (s)