Jhala T, Zundel S, Szavay P
Department of Pediatric Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland.
Department of Pediatric Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland.
J Pediatr Urol. 2021 Dec;17(6):833.e1-833.e4. doi: 10.1016/j.jpurol.2021.09.015. Epub 2021 Sep 24.
To provide a high-fidelity, animal tissue-based model for the advanced surgical simulation of laparoscopic dismembered pyeloplasty in infants and children.
A previously described animal tissue model using chicken crop was surgically modified and attached to piglet kidney specimens in order to provide organ model realistically resembling infant and children hydronephrosis for simulation of dismembered laparoscopic pyeloplasty. Dismembered pyeloplasty could then be carried out in a standard pelvi-trainer using a standard instrumentation as in a regular case.
The model created could prove to be a high-fidelity, animal tissue model for the surgical simulation of dismembered pyeloplasty. The surgical modification of the used animal tissues of chicken crop and piglet kidney respectively used in this fusion model was able to provide a high grade of resembling a realistic organ situs for infant and pediatric pyeloplasty, respectively. The surgical procedure could be carried out as a simulation of a regular case while providing high-grade realistic anatomy, adequate sizes of a dilated renal pelvis and of the ureter, respectively. Biological as well as haptic conditions of the tissue were able to resemble human tissue in a high grade as well.
Despite a live animal model has been described for dismembered pyeloplasty, its time-consuming creation and possible conflict concerning animal welfare cadaver models are more practicable for daily simulation. In literature so far animal-tissue models described range from folded chicken skin to a chicken crop model. While these types of models have its own advantages and disadvantages none of them provide adequate anatomical relations. By dissecting chicken crop and fixating it to a piglet's kidney this limitation could be overcome and furthermore will enable future modifications for a perfused model for laparoscopic dismembered pyeloplasty.
The fusion of a previously described tissue model of chicken crop for simulation of pyeloplasty along with also previously used piglet kidneys for surgical simulation can provide a highly realistic model for surgical simulation of pediatric dismembered laparoscopic pyeloplasty. In addition, this model rules out the disadvantage of native animal kidney specimens which the lack of pathology of a dilated renal pelvis. Surgical modification is an established method to provide high-fidelity animal tissue models for surgical simulation and therefore training of complex procedures, respectively. For simulation purposes in pediatric laparoscopic urology, i.e., reconstructive procedures such as dismembered pyeloplasty this model appears to be promising in terms of providing realistic pathology in pediatric dimensions.
提供一种高保真的、基于动物组织的模型，用于婴幼儿腹腔镜离断式肾盂成形术的高级手术模拟。
对先前描述的使用鸡嗉囊的动物组织模型进行手术改良，并将其附着于仔猪肾脏标本上，以提供逼真模拟婴幼儿肾积水的器官模型，用于模拟腹腔镜离断式肾盂成形术。然后可在标准盆腔训练器中使用常规手术器械进行离断式肾盂成形术模拟，如同实际手术一样。
所创建的模型可证明是用于离断式肾盂成形术手术模拟的高保真动物组织模型。在此融合模型中分别对所用的鸡嗉囊和仔猪肾脏动物组织进行的手术改良，能够分别高度逼真地模拟婴幼儿和小儿肾盂成形术的真实器官位置。手术过程可作为常规病例的模拟进行，同时提供高度逼真的解剖结构、扩张肾盂和输尿管的适当尺寸。组织的生物学和触觉条件也能高度类似于人体组织。
尽管已有用于离断式肾盂成形术的活体动物模型被描述，但其创建耗时且可能存在动物福利方面的问题，尸体模型对于日常模拟更具实用性。迄今为止，文献中描述的动物组织模型范围从折叠的鸡皮到鸡嗉囊模型。虽然这些类型的模型各有优缺点，但均未提供足够的解剖关系。通过解剖鸡嗉囊并将其固定在仔猪肾脏上，这一局限性得以克服，而且未来还能对其进行改良以用于腹腔镜离断式肾盂成形术的灌注模型。
将先前描述的用于肾盂成形术模拟的鸡嗉囊组织模型与先前用于手术模拟的仔猪肾脏相结合，可为小儿腹腔镜离断式肾盂成形术的手术模拟提供高度逼真的模型。此外，该模型排除了天然动物肾脏标本缺乏扩张肾盂病理特征的缺点。手术改良是为手术模拟提供高保真动物组织模型的既定方法，因此分别用于复杂手术的培训。对于小儿腹腔镜泌尿外科的模拟目的，即诸如离断式肾盂成形术等重建手术，该模型在提供小儿尺寸的逼真病理特征方面似乎很有前景。
