registered slaughterhouse and the use of animal by-products was approved by the Netherlands Food and Consumer Product Safety Authority. Laparoscopic Simulation A laparoscopic box training system (Lapstar model 2, Camtronics B.V. Son, Netherlands) with a fixed camera was used to simulate the laparoscopic abdominal surgery. The total small bowel of a porcine cadaver was placed in the laparoscopic box (Figure 1). Participants were instructed to perform the stepwise hand-over-hand technique using two metallic graspers to pass the small bowel in estimated steps of 5 cm (Video 1). The length of the antimesenteric border is measured with the bowel in normal position and without applying traction. In our metabolic bariatric centre, the hand-over-hand measurement technique is the laparoscopic measurement method performed in daily practice. Comparable with the used graspers in metabolic bariatric surgery, one of the instruments had a 4,5 cm marker as reference point. Figure 1: Laparoscopic Set up A. Laparoscopic box trainer, B. Small bowel of the porcine 116 6
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