ABSTRACT Introduction: Determining limb length in gastric bypass procedures is a crucial step to ensure significant weight loss without risking malnutrition. During laparoscopic procedures, the learning curve may lengthen the procedure and cause additional complications risks. This study investigated the effect of ex vivo training on the skills needed to determine limb lengths. Methods: This was a single-centre ex vivo training experiment in a large peripheral teaching hospital in the north of the Netherlands. We designed a training exercise with marked ropes in a laparoscopic trainer box. All ten surgical residents in our teaching hospital participated and practiced the skill of estimating limb length on a marked rope. Before and after the twoweek period their results on a 150-centimetre limb length task were measured on a porcine small bowel model. Results: Before training, 10 surgical residents estimated 150 centimetres of small bowel with an absolute deviation of 21% [range 9-30] from the goal length. After the training experiment, overall, the residents measured with 8% [2-20] deviation (P = 0.17). The results of the 8 residents who trained sufficiently improved statistically significantly to an absolute deviation of 5% [2-17] (P = 0.012). Over 70% of the participants felt their skills had improved. Discussion: With sufficient training, surgical residents’ skills in measuring small bowel length improved when tested in an ex vivo model. Furthermore, residents became more confident in their laparoscopic measurement skills. This ex vivo training model is a relevant alternative and addition to on-site training. Next, the concept can be transferred to other surgical steps and procedures. 132 7
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