Minimally Invasive Surgery Center Jesús Usón. Crta. N-521, Km 41,8. 10071 Cáceres, Spain.
Int J Med Sci. 2013 Jun 21;10(8):1047-52. doi: 10.7150/ijms.6099. Print 2013.
This study aims firstly to assess the most adequate surgical approach for the creation of an ureteropelvic juntion obstruction (UPJO) animal model, and secondly to validate this model for laparoscopic pyeloplasty training among urologists. Thirty six Large White pigs (28.29±5.48 Kg) were used. The left ureteropelvic junction was occluded by means of an endoclip. According to the surgical approach for model creation, pigs were randomized into: laparoscopic conventional surgery (LAP) or single port surgery (LSP). Each group was further divided into transperitoneal (+T) or retroperitoneal (+R) approach. Time needed for access, surgical field preparation, wound closure, and total surgical times were registered. Social behavior, tenderness to the touch and wound inflammation were evaluated in the early postoperative period. After ten days, all animals underwent an Anderson-Hynes pyeloplasty carried out by 9 urologists, who subsequently assessed the model by means of a subjective validation questionnaire. Total operative time was significantly greater in LSP+R (p=0.001). Tenderness to the touch was significantly increased in both retroperitoneal approaches, (p=0.0001). Surgeons rated the UPJO porcine model for training on laparoscopic pyeloplasty with high or very high scores, all above 4 on a 1-5 point Likert scale. Our UPJO animal model is useful for laparoscopic pyeloplasty training. The model created by retroperitoneal single port approach presented the best score in the subjective evaluation, whereas, as a whole, transabdominal laparoscopic approach was preferred.
本研究旨在首先评估创建输尿管肾盂连接梗阻（UPJO）动物模型的最合适手术方法，其次是验证该模型在泌尿科医生腹腔镜肾盂成形术培训中的应用。共使用了 36 头大白猪（28.29±5.48kg）。通过使用 Endoclip 夹闭左输尿管肾盂连接部来建立梗阻模型。根据模型创建的手术方法，将猪随机分为腹腔镜常规手术（LAP）或单端口手术（LSP）组。每组进一步分为经腹腔（+T）或经腹膜后（+R）途径。记录进入、手术野准备、伤口闭合和总手术时间。在术后早期评估社会行为、触诊压痛和伤口炎症。十天后，所有动物均由 9 名泌尿科医生进行 Anderson-Hynes 肾盂成形术，随后由这些医生通过主观验证问卷对模型进行评估。LSP+R 组的总手术时间明显更长（p=0.001）。触诊压痛在两种腹膜后入路中均显著增加（p=0.0001）。外科医生对用于腹腔镜肾盂成形术培训的 UPJO 猪模型的评价均为高或非常高的评分，所有评分均在 1-5 分李克特量表上超过 4 分。我们的 UPJO 动物模型可用于腹腔镜肾盂成形术培训。在主观评价中，经腹膜后单端口入路创建的模型获得了最佳评分，而总体而言，经腹腔腹腔镜入路更受欢迎。
