Sutton Erica R H, Billeter Adrian, Druen Devin, Roberts Henry, Rice Jonathan
Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Clin Transplant. 2017 Jun;31(6). doi: 10.1111/ctr.12979. Epub 2017 Apr 24.
The organ procurement network recommends a surgeon record 15 cases as surgeon or assistant for laparoscopic donor nephrectomies (LDN) prior to independent practice. The literature suggests that the learning curve for improved perioperative and patient outcomes is closer to 35 cases. In this article, we describe our development of a model utilizing fresh tissue and objective, quantifiable endpoints to document surgical progress, and efficiency in each of the major steps involved in LDN.
Phase I of model development focused on the modifications necessary to maintain visualization for laparoscopic surgery in a human cadaver. Phase II tested proposed learner-based metrics of procedural competency for multiport LDN by timing procedural steps of LDN in a novice learner.
Phases I and II required 12 and nine cadavers, with a total of 35 kidneys utilized. The following metrics improved with trial number for multiport LDN: time taken for dissection of the gonadal vein, ureter, renal hilum, adrenal and lumbrical veins, simulated warm ischemic time (WIT), and operative time.
Human cadavers can be used for training in LDN as evidenced by improvements in timed learner-based metrics. This simulation-based model fills a gap in available training options for surgeons.
器官获取网络建议外科医生在独立开展腹腔镜供体肾切除术（LDN）之前，作为术者或助手记录15例该手术。文献表明，要改善围手术期情况及患者预后，学习曲线更接近35例。在本文中，我们描述了我们开发的一个模型，该模型利用新鲜组织以及客观、可量化的终点指标来记录手术进展以及LDN各个主要步骤的效率。
模型开发的第一阶段着重于为在人体尸体上进行腹腔镜手术维持视野所需的改进。第二阶段通过记录新手学习者LDN的手术步骤时间，测试了针对多端口LDN提出的基于学习者的手术能力指标。
第一阶段和第二阶段分别需要12具和9具尸体，总共使用了35个肾脏。对于多端口LDN，以下指标随试验次数的增加而改善：性腺静脉、输尿管、肾门、肾上腺和蚓状静脉的解剖时间、模拟热缺血时间（WIT）和手术时间。
基于学习者的计时指标有所改善，证明人体尸体可用于LDN培训。这种基于模拟的模型填补了外科医生现有培训选项的空白。
