ABSTRACT Introduction: Tailoring limb length in metabolic bariatric surgery is subject of many studies. To acquire the optimal limb length, accurate measurement of the small bowel length is essential. Objective: To assess the intra- and inter-individual variability of laparoscopic bowel length measurement using a hand-over-hand technique with marked graspers. Method: Four metabolic bariatric surgeons and four surgical residents performed measurements on cadaver porcine intestine in a laparoscopic box using marked graspers. Each participant performed 10 times a measurement of three different lengths: 150, 180, and 210 cm. Acceptable percentage deviation from the goal lengths was defined as less than 10%, while unacceptable deviations were defined as more than 15%. Results: The metabolic bariatric surgeons measured the 150, 180, and 210 cm tasks with 4% (CI 0.4, 9), -6% (CI -11, -0.8), and 1% (CI -4, 6) deviation, respectively. In total, the metabolic bariatric surgeons estimated 58 out of 119 times (49%) between the margins of 10% deviation and 36 times (30%) outside the 15% margin. Considerable inter-individual differences were found between the surgeons. The surgical residents underestimated the tasks with 12% (CI - 18, -6), 16% (CI -19, -13), and 18% (CI -22, -13), respectively. Conclusion: Metabolic bariatric surgeons estimated bowel length with on average less than 10% deviation. However, this still resulted in 30% of the measurements with more than 15% deviation. There were considerable inter-individual differences between the surgeons and residents structurally underestimated the bowel length. Ascertainment of measurement accuracy and adequate training is essential for metabolic bariatric procedures in which limb length is of importance. 114 6
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