Huri Emre, Ezer Mehmet, Chan Eddie
Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
Urology Department, Chinese University of Hong Kong School of Medicine, Hong Kong.
Turk J Urol. 2016 Dec;42(4):224-229. doi: 10.5152/tud.2016.84770.
Laparoscopic surgery is routinely used to treat many urological conditions and it is the gold standard treatment option for many surgeries such as radical nephrectomy. Due to the difficulty of learning, laparoscopic training should start outside the operating room. Although it is a very different model of laparoscopic training; the aim of this review is to show the value of human cadaveric model for laparoscopic training and present our experience in this area. Fresh frozen cadaveric model in laparoscopic training, dry lab, cadaveric model, animal models and computer based simulators are the most commonly used models for laparoscopic training. Cadaveric models mimic the live setting better than animal models. Also, it is the best way in demonstrating important anatomic landmarks like prostate, bladder, and pelvic lymph nodes templates. However, cadaveric training is expensive, and should be used by multiple disciplines for higher efficiency. The laparosopic cadaveric training starts with didactic lectures with introduction of pelvic surgical anatomy. It is followed by hands-on dissection. A typical pelvic dissection part can be completed in 6 hours. Surgical robot and some laparoscopy platforms are equipped with 3-D vision. In recent years, we have use the stereoscopic laparoscopy system for training purposes to show exact anatomic landmarks. Cadavers are removed from their containers 3 to 5 days prior to training session to allow enough time for thawing. Intracorporeal suturing is an important part of laparoscopic training. We believe that suturing must be practiced in the dry lab, which is significantly cheaper than cadaveric models. Cadaveric training model should focus on the anatomic dissection instead. In conclusion, fresh-frozen cadaveric sample is one of the best 3D simulation models for laparoscopic training purposes. Major aim of cadaveric training is not only mimicking the surgical technique but also teaching true anatomy. Lack of availability and higher financial cost are the two setbacks for the use of cadavers. Surgeon should learn basic laparoscopic skills with box trainers prior to cadaveric skill training.
腹腔镜手术常用于治疗多种泌尿外科疾病，是许多手术（如根治性肾切除术）的金标准治疗选择。由于学习难度较大，腹腔镜培训应在手术室之外开始。尽管这是一种截然不同的腹腔镜培训模式，但本综述的目的是展示人体尸体模型在腹腔镜培训中的价值，并介绍我们在该领域的经验。腹腔镜培训中最常用的模型包括新鲜冷冻尸体模型、模拟实验室、尸体模型、动物模型和基于计算机的模拟器。尸体模型比动物模型更能模拟真实场景。此外，它是展示前列腺、膀胱和盆腔淋巴结模板等重要解剖标志的最佳方式。然而，尸体培训成本高昂，应由多个学科共同使用以提高效率。腹腔镜尸体培训首先是关于盆腔手术解剖学的理论讲座，随后是实际操作解剖。一个典型的盆腔解剖部分可以在6小时内完成。手术机器人和一些腹腔镜平台配备了三维视觉。近年来，我们使用立体腹腔镜系统进行培训，以展示精确的解剖标志。在培训前3至5天从容器中取出尸体，以便有足够的时间解冻。体内缝合是腹腔镜培训的重要组成部分。我们认为，缝合必须在模拟实验室中练习，这比尸体模型便宜得多。尸体培训模型应侧重于解剖解剖。总之，新鲜冷冻尸体样本是用于腹腔镜培训目的的最佳三维模拟模型之一。尸体培训的主要目的不仅是模仿手术技术，还包括教授真实的解剖学知识。尸体可用性不足和成本较高是使用尸体的两个障碍。外科医生在进行尸体技能培训之前，应使用箱式训练器学习基本的腹腔镜技能。
