Abstract
PurposeAccurate laparoscopic bowel length measurement (LBLM), which is used primarily in metabolic surgery, remains a challenge. This study aims to three conventional methods for LBLM, namely using visual judgment (VJ), instrument markings (IM), or premeasured tape (PT) to a novel computer-assisted 3D measurement system (BMS).Materials and MethodsLBLM methods were compared using a 3D laparoscope on bowel phantoms regarding accuracy (relative error in percent, %), time in seconds (s), and number of bowel grasps. Seventy centimeters were measured seven times. As a control, the first, third, fifth, and seventh measurements were performed with VJ. The interventions IM, PT, and BMS were performed following a randomized order as the second, fourth, and sixth measurements.ResultsIn total, 63 people participated. BMS showed better accuracy (2.1±3.7%) compared to VJ (8.7±13.7%, p=0.001), PT (4.3±6.8%, p=0.002), and IM (11±15.3%, p<0.001). Participants performed LBLM in a similar amount of time with BMS (175.7±59.7s) and PT (166.5±63.6s, p=0.35), but VJ (64.0±24.0s, p<0.001) and IM (144.9±55.4s, p=0.002) were faster. Number of bowel grasps as a measure for the risk of bowel lesions was similar for BMS (15.8±3.0) and PT (15.9±4.6, p=0.861), whereas VJ required less (14.1±3.4, p=0.004) and IM required more than BMS (22.2±6.9, p<0.001).ConclusionsPT had higher accuracy than VJ and IM, and lower number of bowel grasps than IM. BMS shows great potential for more reliable LBLM. Until BMS is available in clinical routine, PT should be preferred for LBLM.Graphical abstract
Highlights
The goal of this study was to compare existing methods for laparoscopic bowel length measurement (LBLM) with a novel computer-assisted 3D bowel measurement system (BMS) [1, 2].Because of its numerous benefits for the patient, laparoscopic surgery has become the standard approach for a number of surgical procedures [3,4,5]
This study aims to answer the research questions (1) whether a novel computer-assisted 3D measurement system is superior to previous LBLM methods and (2) how different LBLM methods compare regarding accuracy, measurement time, and the number of bowel grasps as a measure for the risk of bowel lesions
The accuracy of LBLM was higher with BMS than with premeasured tape (PT), instrument markings (IM), or visual judgment (VJ) and higher with PT than with VJ or IM (Fig. 4)
Summary
The goal of this study was to compare existing methods for laparoscopic bowel length measurement (LBLM) with a novel computer-assisted 3D bowel measurement system (BMS) [1, 2].Because of its numerous benefits for the patient, laparoscopic surgery has become the standard approach for a number of surgical procedures [3,4,5]. Robotics and 3D-imaging technology have been proposed — and partially implemented — as a means of overcoming these problems [7], but no clinical standard for facilitating objective length or volume measurements laparoscopically exists. This aspect can be of significant clinical importance, e.g., when determining the extent of bowel resection during laparoscopic treatment of Crohn’s disease [8] or when ensuring adequate resection margins during laparoscopic treatment of colorectal cancer [9]. Determining the correct limb length in bariatric procedures is relevant for treatment success [12,13,14,15]. Methods for laparoscopic bowel length measurement (LBLM) have not been sufficiently assessed in clinical trials [17, 18], and there is no evidence for the superiority of one method of LBLM over the others [19]
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