The LeakChecker: quantitative air leakage assessment in laparoscopic intestinal anastomosis training

Background: Performing an intestinal anastomosis is a challenging part of laparoscopic surgery, and ensuring adequate closure is essential to prevent anastomotic leakage. The aim of this study was to develop an objective method for quantitative assessment of laparoscopic intestinal anastomosis during simulation training. Methods: A modular intraluminal air leakage device, the LeakChecker, was designed and validated by comparing laparoscopic intestinal anastomoses performed by laparoscopic novices and experts. The MaxForce, MeanNon-zero force, PathLength and DepthPerception parameters from the Lapron box-trainer vs MaxPressure and PressureArea from the LeakChecker were used for comparison. Results: A functional prototype was built and the data of 10 laparoscopic novices and seven experts were included. Anastomoses made by the experts tolerated a higher MaxPressure (3,10(2,51-7,24)kPa vs 0,98(0,81-1,35)kPa; p=0.010) and showed a higher pressureArea (24,89(16,13-100,04)kPa*t vs 5,99(4,78-9,23)kPa*t; p=0.032). The Lapron box trainer data showed significant differences between the experts and novices for almost all including force and motion parameters. Conclusion: The LeakChecker can quantify anastomotic leakage during training as it objectively distinguishes between novices and experts. Implementing this kind of smart training task in a training program with objective skill assessment would inform participants of both their instrument handing skills and the quality of their execution.