APPENDIX C Comparison of Key Steps of the Laparoscopic Roux-en-Y Gastric Bypass Zevin et al.1 BOSATS Expert Delphi consensus 12 steps Kaijser et al.2 Procedural key steps Expert Delphi consensus 6 steps Ramesh et al.3 AI video segmenta2on Expert consensus 11 steps 1. Paqent posiqoning 1. Operaqve set-up 1. Preparaqon 2. Abdominal access and port inserqon 2. Starqng the laparoscopy 3. Placement of liver retractor 3. Omentum division 4. Creaqon of Roux limb 5. Alimentary limb jejunojejunal anastomosis 6. Jejunal separaqon 5. Creaqon of jejunojejunal anastomosis 8. Jejunojejunal anastomosis 6. Dissecqon of phrenoesophageal ligament 3. Creaqon of the gastric pouch 2. Gastric pouch creaqon 7. Creaqon of gastric pouch 8. Posiqoning of Roux limb 4. Biliopancreaqc limb and gastrojejunal anastomosis 4. Gastrojejunal anastomosis 9. Creaqon of gastrojejunal anastomosis 10. Closure of potenqal hernia sites 7. Closure Petersen’s space 9. Closure mesenteric defect 11. Tesqng of gastrojejunal anastomosis 6. Finishing bypass and operaqon 5. Anastomosis test 10. Cleaning coagulaqon 12. Removal of ports and closure of port sites 11. Dissembling Author, goal, task analysis, number of steps and comparison of the defined key steps References 1. Zevin B, Bonrath EM, Aggarwal R, Dedy NJ, Ahmed N, Grantcharov TP. Development, feasibility, validity, and reliability of a scale for objective assessment of operative performance in laparoscopic gastric bypass surgery. J Am Coll Surg. 2013;216(5):955-965.e8. 2. Kaijser MA, van Ramshorst GH, Emous M, Veeger NJGM, van Wagensveld BA, Pierie JPEN. A Delphi Consensus of the Crucial Steps in Gastric Bypass and Sleeve Gastrectomy Procedures in the Netherlands. Obes Surg. 2018;28(9):2634-2643. 3. Ramesh S, Dall’Alba D, Gonzalez C, et al. Multi-task temporal convolutional networks for joint recognition of surgical phases and steps in gastric bypass procedures. Int J Comput Assist Radiol Surg. 2021;16(7):1111-1119. A 187 Appendix A-F
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