82 | wetenschapsdag 2023 Sessie 2d: Laparos: het Ontwerp Binnenste Binnen Keren x5 Auteurs A. M. Rahimi, T. Kamra, S. Hardon, H.J. Bonjer, T.Horeman, Freek Daams Abstract titel Advanced Laparoscopic Suturing training: the price you pay for barbed sutures vs. multifilament sutures. Background Laparoscopic suturing is a fundamental surgical skill that requires extensive training. The introduction of barbed sutures has simplified laparoscopic suturing; however, mastering these techniques necessitates adequate simulation training. This study aimed to develop advanced suturing training tasks for intestinal anastomosis and vaginal cuff repair using both multifilament and barbed sutures, while objectively measuring differences in tissue manipulation between these suture types. Methods This prospective cohort study involved 14 European training hospitals, with participants including junior surgical residents (n=35) and experienced laparoscopic surgeons (n=18) for intestinal anastomosis, as well as experienced laparoscopic gynecologists (n=10) for vaginal cuff repair. The Lapron box trainer provided feedback on tissue manipulation, path length, instrument efficiency, and time. Participants performed laparoscopic intestinal anastomosis and vaginal cuff repair on artificial tissue using both multifilament sutures and V-loc. Results For intestinal anastomosis, novices using V-loc sutures demonstrated reduced maximum impulse, force volume, total path length, volume of motion, and total time but exhibited higher mean force compared to multifilament sutures. In experts, V-loc sutures significantly reduced total path length and total completion time while increasing mean force. In vaginal cuff repair, V-loc sutures resulted in a shorter total path length and total completion time. Maximum force, mean force, standard deviation of force, and force volume were also increased with V-loc sutures. Conclusion V-loc suture material demonstrated advantages over traditional multifilament suture material by reducing path length, completion time, and increasing mean force and stability for both intestinal anastomosis and vaginal cuff repair. The differences in tissue manipulation underscore the importance of objective performance assessment to guide training and proficiency standards in laparoscopic suturing.
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