Esposito Ciro, Escolino Maria, Draghici Isabela, Cerulo Mariapina, Farina Alessandra, De Pascale Teresa, Cozzolino Santolo, Settimi Alessandro
1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy .
2 Department of Pediatric Surgery, Maria Sklodowska Curie Hospital for Children , Bucharest, Romania .
J Laparoendosc Adv Surg Tech A. 2016 Jan;26(1):79-84. doi: 10.1089/lap.2015.0229. Epub 2015 Nov 30.
The porcine model is the most widely used animal model for laparoscopic training. However, in pediatric surgery, an experimental setting with smaller animals could improve the training conditions. We compared the efficiency of a rabbit model versus the porcine model for training in pediatric minimally invasive surgery (MIS).
At the training center of Cardarelli Hospital in Naples, Italy, 10 young pediatric surgeons underwent training sessions on rabbit and porcine models under the supervision of five experienced tutors. The results of four laparoscopic techniques (inguinal hernia repair, varicocelectomy [basic procedures], nephrectomy, and fundoplication [advanced procedures]) were evaluated in regard to mean operative time, intraoperative complications, and surgical performances. Results were analyzed using Fisher's exact test and Student's t test.
Practitioners were significantly more confident in the rabbit model compared with the pig model, especially for advanced procedures (P = .03). The overall surgical performance score (ranging from 0 [unacceptable] to 10 [excellent]) was significantly higher in the rabbit model compared with the pig model (8.1 versus 6.0; P = .01). The most significant scoring differences between the surgical performances of the trainees in the two models were reported in regard to dissection, suturing and knot-tying, tissue handling, and handling of instruments. In addition, the length of surgery for advanced procedures was statistically shorter in the rabbit model compared with the pig model (P = .01). We found that only the performances of those who started on the pig had a significantly higher improvement when transitioning to the rabbit compared with those who started on the rabbit (P = .01). Of the trainees, 90% preferred the rabbit model to the pig model.
On the basis of our preliminary results, rabbits are preferred over pigs as the training model in pediatric MIS. In the rabbit model it is possible to perform more procedures and perform them more easily compared with the porcine model. The rabbit model provides a comfortable approach to technical training in basic and advanced laparoscopic procedures.
猪模型是腹腔镜训练中使用最广泛的动物模型。然而，在小儿外科中，使用体型较小的动物进行实验设置可能会改善训练条件。我们比较了兔模型和猪模型在小儿微创手术（MIS）训练中的效率。
在意大利那不勒斯卡雷利医院的培训中心，10名年轻的小儿外科医生在5名经验丰富的带教老师的监督下，在兔模型和猪模型上进行训练课程。对四种腹腔镜技术（腹股沟疝修补术、精索静脉曲张切除术[基本手术]、肾切除术和胃底折叠术[高级手术]）的结果进行了评估，包括平均手术时间、术中并发症和手术表现。结果采用Fisher精确检验和Student t检验进行分析。
与猪模型相比，从业者对兔模型的信心明显更高，尤其是在高级手术方面（P = 0.03）。与猪模型相比，兔模型的总体手术表现评分（范围从0[不可接受]到10[优秀]）明显更高（8.1对6.0；P = 0.01）。在解剖、缝合和打结、组织处理以及器械操作方面，两个模型中学员的手术表现得分差异最为显著。此外，与猪模型相比，兔模型中高级手术的手术时间在统计学上更短（P = 0.01）。我们发现，只有那些从猪模型开始训练的人在过渡到兔模型时，与从兔模型开始训练的人相比，表现有显著更高的提升（P = 0.01）。在学员中，90%的人更喜欢兔模型而不是猪模型。
根据我们的初步结果，在小儿MIS训练中，兔比猪更适合作为训练模型。与猪模型相比，在兔模型中可以进行更多的手术，并且操作更容易。兔模型为基础和高级腹腔镜手术的技术训练提供了一种舒适的方法。
