Cacciamani G, De Marco V, Siracusano S, De Marchi D, Bizzotto L, Cerruto M A, Motton G, Porcaro A B, Artibani W
Department of Urology, University of Verona, Verona, Italy.
Si.F.A.R.V. Centro di Simulazione e Formazione Avanzata della Regione Veneto, Verona, Italy.
J Robot Surg. 2017 Jun;11(2):123-128. doi: 10.1007/s11701-016-0626-4. Epub 2016 Jul 20.
A training model is usually needed to teach robotic surgical technique successfully. In this way, an ideal training model should mimic as much as possible the "in vivo" procedure and allow several consecutive surgical simulations. The goal of this study was to create a "wet lab" model suitable for RARP training programs, providing the simulation of the posterior fascial reconstruction. The second aim was to compare the original "Venezuelan" chicken model described by Sotelo to our training model. Our training model consists of performing an anastomosis, reproducing the surgical procedure in "vivo" as in RARP, between proventriculus and the proximal portion of the esophagus. A posterior fascial reconstruction simulating Rocco's stitch is performed between the tissues located under the posterior surface of the esophagus and the tissue represented by the serosa of the proventriculus. From 2014 to 2015, during 6 different full-immersion training courses, thirty-four surgeons performed the urethrovesical anastomosis using our model and the Sotelo's one. After the training period, each surgeon was asked to fill out a non-validated questionnaire to perform an evaluation of the differences between the two training models. Our model was judged the best model, in terms of similarity with urethral tissue and similarity with the anatomic unit urethra-pelvic wall. Our training model as reported by all trainees is easily reproducible and anatomically comparable with the urethrovesical anastomosis as performed during radical prostatectomy in humans. It is suitable for performing posterior fascial reconstruction reported by Rocco. In this context, our surgical training model could be routinely proposed in all robotic training courses to develop specific expertise in urethrovesical anastomosis with the reproducibility of the Rocco stitch.
通常需要一个训练模型来成功教授机器人手术技术。通过这种方式，理想的训练模型应尽可能模仿“体内”手术过程，并允许进行连续多次手术模拟。本研究的目的是创建一个适用于机器人辅助根治性前列腺切除术（RARP）培训项目的“湿实验室”模型，以模拟后筋膜重建。第二个目的是将索特洛描述的原始“委内瑞拉”鸡模型与我们的训练模型进行比较。我们的训练模型包括进行吻合术，即在腺胃和食管近端之间重现RARP中的“体内”手术过程。在食管后表面下方的组织与腺胃浆膜所代表的组织之间进行模拟罗科缝合的后筋膜重建。2014年至2015年期间，在6个不同的全沉浸式培训课程中，34名外科医生使用我们的模型和索特洛的模型进行了尿道膀胱吻合术。培训期结束后，要求每位外科医生填写一份未经验证的问卷，以评估两种训练模型之间的差异。就与尿道组织的相似性以及与尿道-盆腔壁解剖单元的相似性而言，我们的模型被判定为最佳模型。据所有学员报告，我们的训练模型易于重现，并且在解剖学上与人类根治性前列腺切除术中进行的尿道膀胱吻合术具有可比性。它适用于进行罗科报告的后筋膜重建。在这种情况下，我们的手术训练模型可以在所有机器人培训课程中常规推荐，以培养在尿道膀胱吻合术中具有罗科缝合可重复性的特定专业技能。
