For this they used the GOALS study of Vassilou et al. to support a relevant difference between novice and expert of 6.4, with a standard deviation of 4.5 and combined this with the power set at 0.8 and an alpha of 0.05.25 As three expertise levels and three procedural steps were included, this study involved 9 assessments. 12 experts were identified as assessors to ensure the expected sample size of 8 - 10 was reached. Video-Recordings Video recordings from LRYGB performed by residents and surgeons were selected from a highvolume metabolic bariatric centre in the Netherlands. In metabolic bariatric procedures a Endoeye HD II camera (© 2020 Olympus America) is used. Recordings are made and stored with the IBoxTouchCompact system (© meso international GmbH). Two residents were selected, a beginner who had performed < 10 LRYGB and an intermediate experienced resident, who had participated in 10 - 100 procedures as 1st surgeon. Moreover, one metabolic bariatric surgeon with 10 years of experience was selected to include an expert level procedure. All agreed to participate and gave written consent. The OR logs were reviewed and the most recent cases meeting the inclusion criteria were included: all standard metabolic bariatric cases, i.e., female subjects with a BMI < 45 kg/m2 without previous abdominal surgery. After explicit and written consent of the patients to use the anonymous recording of the performed procedure for research and educational purposes, these recordings were downloaded and edited before publication on the study website. Video-Editing Video recordings were edited with IMovie version 10.2.1 (© 2001-2020 Apple Inc.). The recorded cases show a LRYGB performed with a linear stapling technique of both the jejunojejunostomy and the antecolic antegastric gastrojejunal anastomosis. In this study only the PBA fragments of entirely laparoscopic and crucial steps were selected: the creation of the pouch, the biliopancreatic limb (BPL) and gastrojejunostomy (GJ) and third the alimentary limb (AL) and jejunojejunostomy (JJ). Fragments were selected starting from the first grasp and retraction of stomach and lesser omentum to start the pouch, up to retraction of the camera after completing the pouch in the angle of His. For the BPL and GJ fragment recording was started at the first attempt of grasping the pouch to open it for the stapler -up to the completion of the anastomosis by cutting the last stitch. For the alimentary limb and JJ the 5 85 A new procedure-based assessment in gastric bypass surgery
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