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A new platform for laparoscopic training: initial evaluation of the ex-vivo live multivisceral training device

机译：腹腔镜训练的新平台：初步评估前体内现场多民族训练装置

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摘要

Background Various training models have been developed for laparoscopic training. Inanimate models including cadavers, ex-vivo simulator, and virtual reality (VR), are less realistic and often fail to display specific events such as bleeding, bile leakage, etc. Animal models provide more realistic experience, but constraints like cost involved, anesthetic requirement, and ethical approval have limited its application. We have designed a new training ex-vivo simulator-Smagister to address these issues. Methods The Smagister consists of a normothermic machine perfusion platform, multivisceral organ of porcine abdominal cavity (liver, gallbladder, pancreas, stomach, intestine, kidney, uterus, bladders, etc.), high-definition display, and software system. Blood gas analysis and number of peristalsis per hour were recorded. A questionnaire was used to subjectively assess vitality of the organ cluster every hour. Three laparoscopic procedures including cholecystectomy (LC), enterotomy closure (LEC) and hepatectomy (LLR) were performed on Smagister, with demonstration of specific events for each procedure. Six experts compared the procedures with actual surgery in terms of feasibility to complete procedures and demonstration of complications. Results The fluctuation of perfusate glucose (6.1-8.2 mmol/L) and lactate (5.82-6.55 mmol/L) suggested metabolic function of the multivisceral organs. The mean number of peristalsis was 2.2/min. The simulated surgical view and anatomic structures closely resembled actual surgery during continuous perfusion (3.5 +/- 1.0, 3.8 +/- 0.8, respectively). The evaluation scores of haptic feedbacks were 3.8 +/- 0.8, resembling live tissue handling. LC, LEC, and LLR were performed well on the Smagister, with clear display of the specific events. All six experts considered Smagister as a suitable training modality for both basic and advanced laparoscopic surgery. Conclusion The amalgamation of live animal model and ex-vivo simulation in Smagister centralizes the virtue of both modalities, expands the training field, and provides high-fidelity laparoscopic training for both novice and senior surgeons.
机译：背景各种训练模式已经被开发用于腹腔镜训练。包括尸体、离体模拟器和虚拟现实（VR）在内的无生命模型不太真实，通常无法显示出血、胆漏等特定事件。动物模型提供了更真实的体验，但成本、麻醉要求和伦理批准等限制因素限制了其应用。我们设计了一个新的体外训练模拟器Smagister来解决这些问题。方法Smagister由常温机器灌注平台、猪腹腔多脏器（肝、胆、胰、胃、肠、肾、子宫、膀胱等）、高清显示和软件系统组成。记录血气分析和每小时蠕动次数。每小时使用一份问卷对器官群的活力进行主观评估。在Smagister上进行了三种腹腔镜手术，包括胆囊切除术（LC）、肠切开闭合术（LEC）和肝切除术（LLR），并展示了每种手术的具体事件。六位专家就完成手术的可行性和并发症的表现将手术与实际手术进行了比较。结果灌流葡萄糖（6.1-8.2mmol/L）和乳酸（5.82-6.55mmol/L）的波动提示多脏器的代谢功能。平均蠕动次数为2.2/min。在持续灌注期间，模拟手术视图和解剖结构与实际手术非常相似（分别为3.5+/-1.0和3.8+/-0.8）。触觉反馈的评估分数为3.8+/-0.8，类似于活组织处理。LC、LEC和LLR在Smagister上表现良好，具体事件显示清晰。所有六位专家都认为Smagister是基础和高级腹腔镜手术的合适培训方式。结论Smagister中活体动物模型和体外模拟的融合集中了两种模式的优点，扩展了培训领域，为新手和高级外科医生提供了高保真的腹腔镜培训。

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  • 来源
    《Surgical Endoscopy》 |2021年第1期|共9页
  • 作者

    Wang Xiaobo; Zhang Kunsong; Hu Wenjie; Kuang Ming; Teo Serene; Guo Zhiyong; Zhao Qiang; He Xiaoshun;

  • 作者单位

    Sun Yat Sen Univ Affiliated Hosp 1 Organ Transplant Ctr Guangzhou 510080 Peoples R China;

    Sun Yat Sen Univ Affiliated Hosp 1 Dept Hepatobiliary Surg Guangzhou Guangdong Peoples R China;

    Sun Yat Sen Univ Affiliated Hosp 1 Dept Hepatobiliary Surg Guangzhou Guangdong Peoples R China;

    Sun Yat Sen Univ Affiliated Hosp 1 Dept Hepatobiliary Surg Guangzhou Guangdong Peoples R China;

    Univ Glasgow Fac Med Glasgow Lanark Scotland;

    Sun Yat Sen Univ Affiliated Hosp 1 Organ Transplant Ctr Guangzhou 510080 Peoples R China;

    Sun Yat Sen Univ Affiliated Hosp 1 Organ Transplant Ctr Guangzhou 510080 Peoples R China;

    Sun Yat Sen Univ Affiliated Hosp 1 Organ Transplant Ctr Guangzhou 510080 Peoples R China;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    Laparoscopic training; Simulator; Live; Multivisceral organs; Specific events;

    机译：腹腔镜训练;模拟器;居住多脏器;具体事件;

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