Surgical Endoscopy

, Volume 29, Issue 2, pp 444–452

Objective assessment of the suture ligature method for the laparoscopic intestinal anastomosis model using a new computerized system

  • Munenori Uemura
  • Makoto Yamashita
  • Morimasa Tomikawa
  • Satoshi Obata
  • Ryota Souzaki
  • Satoshi Ieiri
  • Kenoki Ohuchida
  • Noriyuki Matsuoka
  • Tamotsu Katayama
  • Makoto Hashizume



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.


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.


The volumes of air pressure leak in the expert and novice groups were 21.13 ± 6.68 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 and 11.06 ± 15.37 mm2, respectively. The performance times in the expert and novice groups were 349 ± 120 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 except for the number of full-thickness sutures was statistically defined by the performance of the expert group.


Our system is useful for the quantitative assessment of suturing skill in laparoscopic surgery. We believe that this system is a useful tool for training and assessment of laparoscopic surgeons.


Laparoscopic surgery Surgical training Internal pressure Image analysis Artificial intestine Objective assessment 


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Munenori Uemura
    • 1
  • Makoto Yamashita
    • 2
  • Morimasa Tomikawa
    • 2
  • Satoshi Obata
    • 2
  • Ryota Souzaki
    • 2
  • Satoshi Ieiri
    • 2
  • Kenoki Ohuchida
    • 1
  • Noriyuki Matsuoka
    • 3
  • Tamotsu Katayama
    • 3
  • Makoto Hashizume
    • 1
    • 2
  1. 1.Center for Advanced Medical InnovationKyushu UniversityFukuokaJapan
  2. 2.Department of Advanced Medical Initiatives, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  3. 3.Kyoto Kagaku Co., LtdKyotoJapan

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