Schlottmann Francisco, Murty Neal S, Patti Marco G
1 Department of Surgery, Hospital Alemán of Buenos Aires , Buenos Aires, Argentina .
2 Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
J Laparoendosc Adv Surg Tech A. 2017 Jul;27(7):661-665. doi: 10.1089/lap.2017.0138. Epub 2017 May 24.
A significant gap presently exists between box-lap and virtual-reality simulators and live surgery. Live animal and cadaver use has significant downsides. We have developed a high fidelity, real tissue simulator that allows training in laparoscopic foregut operations.
Our foregut surgery model is based on porcine tissue blocks that include lungs, heart, aorta, esophagus, diaphragm, stomach, duodenum, liver, and spleen. The tissue block is mounted in a human mannequin and perfused with artificial blood. The anterior abdominal wall is constructed so as to allow for laparoscopic or robotic surgical training. We sought to test the model with procedures performed by expert surgeons. After completing the procedures, face validity was measured by surgeon responses to a questionnaire defining the perceived relationship to real surgery.
Five expert foregut surgeons performed laparoscopic Heller myotomy, Nissen fundoplication, and sleeve gastrectomy on the model. The simulator was rated as highly realistic in terms of tissue feel, instrument usage, and conduct of the operation for all three procedures. In addition, all surgeons felt the model could significantly shorten the learning curve for performing these procedures.
The results of this study show that our simulation model, based on animal tissue blocks, offers a very realistic representation of laparoscopic foregut operations, thus achieving a high level of face validity. The model should be very useful for training surgeons in laparoscopic foregut procedures.
目前，箱式模拟训练器和虚拟现实模拟器与实际手术之间存在显著差距。使用活体动物和尸体进行训练存在诸多不利之处。我们开发了一种高保真的真实组织模拟器，可用于腹腔镜前肠手术的训练。
我们的前肠手术模型基于包含肺、心脏、主动脉、食管、膈肌、胃、十二指肠、肝脏和脾脏的猪组织块。将组织块安装在人体模型中，并灌注人造血液。构建前腹壁以便进行腹腔镜或机器人手术训练。我们试图让专家外科医生用该模型进行手术操作来测试它。完成手术后，通过外科医生对一份定义了与实际手术感知关系的问卷的回答来衡量表面效度。
五位前肠外科专家在该模型上进行了腹腔镜Heller肌切开术、nissen胃底折叠术和袖状胃切除术。对于所有这三种手术，模拟器在组织触感、器械使用和手术操作方面都被评为高度逼真。此外，所有外科医生都认为该模型可以显著缩短进行这些手术的学习曲线。
本研究结果表明，我们基于动物组织块的模拟模型非常逼真地呈现了腹腔镜前肠手术，从而具有较高的表面效度。该模型对于培训外科医生进行腹腔镜前肠手术应该非常有用。
