Surgical Endoscopy

, Volume 32, Issue 9, pp 4052–4061 | Cite as

Computer-assisted 3D bowel length measurement for quantitative laparoscopy

  • Martin Wagner
  • Benjamin Friedrich Berthold Mayer
  • Sebastian Bodenstedt
  • Katherine Stemmer
  • Arash Fereydooni
  • Stefanie Speidel
  • Rüdiger Dillmann
  • Felix Nickel
  • Lars Fischer
  • Hannes Götz KenngottEmail author
New Technology



This study aimed at developing and evaluating a tool for computer-assisted 3D bowel length measurement (BMS) to improve objective measurement in minimally invasive surgery. Standardization and quality of surgery as well as its documentation are currently limited by lack of objective intraoperative measurements. To solve this problem, we developed BMS as a clinical application of Quantitative Laparoscopy (QL).


BMS processes images from a conventional 3D laparoscope. Computer vision algorithms are used to measure the distance between laparoscopic instruments along a 3D reconstruction of the bowel surface. Preclinical evaluation was performed in phantom, ex vivo porcine, and in vivo porcine models. A bowel length of 70 cm was measured with BMS and compared to a manually obtained ground truth. Afterwards 70 cm of bowel (ground truth) was measured and compared to BMS.


Ground truth was 66.1 ± 2.7 cm (relative error + 5.8%) in phantom, 65.8 ± 2.5 cm (relative error + 6.4%) in ex vivo, and 67.5 ± 6.6 cm (relative error + 3.7%) in in vivo porcine evaluation when 70 cm was measured with BMS. Using 70 cm of bowel, BMS measured 75.0 ± 2.9 cm (relative error + 7.2%) in phantom and 74.4 ± 2.8 cm (relative error + 6.3%) in ex vivo porcine evaluation. After thorough preclinical evaluation, BMS was successfully used in a patient undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity.


QL using BMS was shown to be feasible and was successfully translated from studies on phantom, ex vivo, and in vivo porcine bowel to a clinical feasibility study.


Quantitative laparoscopy Bowel measurement 3D laparoscopy Computer-assisted surgery Roux-en-Y gastric bypass 



We thank Simon Mayer, School of Design of Pforzheim University, Germany, for the design of the graphical user interface.


This work was supported by the German Research Foundation (DFG) within the project A01 of the transregional collaborative research center 125 “Cognition-Guided Surgery” (principal investigator Stefanie Speidel) and by Heidelberg University Medical School with a Physician-Scientist-Fellowship for Martin Wagner.

Compliance with ethical standards


Martin Wagner and Hannes Götz Kenngott work with device manufacturer Karl Storz GmbH & Co. KG in the joint research project “InnOPlan,” funded by the German Federal Ministry of Economic Affairs and Energy (grant number BMWI 01MD15002E). Sebastian Bodenstedt and Stefanie Speidel work with device manufacturer Karl Storz GmbH & Co. KG in the joint research project “OP4.1,” funded by the German Federal Ministry of Economic Affairs and Energy (grant number BMWI 01MT17001C). Benjamin Friedrich Berthold Mayer, Katherine Stemmer, Arash Fereydooni, Rüdiger Dillmann, Felix Nickel, and Lars Fischer have no conflict of interest or financial ties to disclose.

Supplementary material

Supplementary material video 1. Demonstration of bowel measurement system with measurement sequence during first in human study (MP4 58860 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Martin Wagner
    • 1
  • Benjamin Friedrich Berthold Mayer
    • 1
  • Sebastian Bodenstedt
    • 2
  • Katherine Stemmer
    • 1
  • Arash Fereydooni
    • 1
  • Stefanie Speidel
    • 2
  • Rüdiger Dillmann
    • 3
  • Felix Nickel
    • 1
  • Lars Fischer
    • 1
  • Hannes Götz Kenngott
    • 1
    Email author
  1. 1.Department of General, Visceral and Transplant SurgeryUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Translational Surgical OncologyNational Center for Tumor Diseases – Partner Site DresdenDresdenGermany
  3. 3.Institute for Anthropomatics and RoboticsKarlsruhe Institute of TechnologyKarlsruheGermany

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