Donias Harry W, Schwartz Ted, Tang Daniel G, DeAnda Abe, Tabaie Harold A, Boyd Douglas W, Karamanoukian Hratch L
Department of Surgery, State University of New York at Buffalo, Buffalo, New York, USA.
Heart Surg Forum. 2003;6(4):249-53.
The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis.
An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test.
Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical significance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P <.0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P =.0049).
This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.
机器人辅助冠状动脉手术的应用仍在临床研究中。因此，需要一种简单的方法来培训外科医生进行这些手术。本研究的目的是评估一种使用离体猪心脏的模型，用于培训外科医生进行机器人辅助动脉吻合术。
用猪心脏构建一个离体跳动心脏模型，并由3名先前接受过机器人手术培训的心脏外科医生进行评估。对研究前半部分的所有吻合术进行回顾，以测量吻合时间、放置的缝线数量和每分钟的缝线放置速率，并通过不成对学生t检验与研究后半部分完成的吻合术进行比较。
使用跳动心脏模型完成了57例吻合术，研究前半部分28例，后半部分29例。研究前半部分创建一个吻合术的平均时间为19.3分钟（范围10 - 28分钟），后半部分为15.0分钟（范围7 - 20分钟）；差异无统计学意义。然而，研究后半部分每分钟放置的缝线数量确实增加了，平均为每分钟0.77针（范围0.55 - 1.25），而研究前半部分为每分钟0.56针（范围0.40 - 0.80）（P <.0001）。研究后半部分每个吻合术的缝线数量也减少了，平均为9.0针（范围8 - 11），而研究前半部分为10.6针（范围8 - 16）（P =.0049）。
这一初步经验表明研究后半部分有技术改进。每个吻合术放置的缝线更少且精度更高，这意味着我们的模型可以加速学习曲线。这种猪跳动心脏模型代表了一种廉价的培训方法，可模拟跳动心脏及完整的冠状动脉血流，并且可以多次用于培训和评估外科医生在机器人辅助冠状动脉手术中的技能。
