Department of Pediatric Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland.
Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
J Pediatr Surg. 2023 Oct;58(10):1916-1920. doi: 10.1016/j.jpedsurg.2023.02.055. Epub 2023 Feb 23.
To provide a high-fidelity, animal tissue-based model for the advanced surgical simulation of a Posterior Sagittal Anorectoplasty (PSARP) for rectovestibular fistula in anorectal malformation (ARM).
A chicken cadaver was used to assess the feasibility of simulating a PSARP for rectovestibular fistula in ARM. No modification was required to implement the surgical simulation.
A detailed description of the high-fidelity surgical simulation model is provided. The PSARP can be simulated while providing realistic anatomy (e.g. common wall between rectovestibular fistula and vagina), adequate rectal size, location and placement of the rectovestibular fistula, and proximity to the vagina. Haptic conditions of the tissue resemble human tissue and operative conditions as well.
Concerning the decreased exposure of index cases of pediatric surgical trainees and pediatric surgeons in practice, simulation-based training can provide means to acquire or maintain the necessary skills to perform complex surgical procedures [1-5] Surgical simulation models for ARM are limited. Few low-cost trainers are available with predominant artificial and mostly unrealistic tissue [6-8] Animal models have the advantage of realistic multilayer tissue haptic feedback [6].
We provide a low-cost, high-fidelity model for correcting a rectovestibular fistula in a child with ARM, a complex operative procedure with low incidence but high-stake outcomes. The described tissue model utilizing the chicken cloaca anatomy provides a high-fidelity model for operative correction of rectovestibular ARM. For simulation purposes in the treatment of ARM, this model appears to be promising in terms of providing realistic pathology and haptic feedback in pediatric dimensions.
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为肛门直肠畸形（ARM）直肠阴道瘘的后矢状位直肠肛门成形术（PSARP）的高级手术模拟提供高保真度、基于动物组织的模型。
使用鸡尸体来评估模拟 ARM 直肠阴道瘘 PSARP 的可行性。无需修改即可实施手术模拟。
提供了高保真手术模拟模型的详细描述。可以模拟 PSARP，同时提供真实的解剖结构（例如直肠阴道瘘和阴道之间的共同壁）、足够的直肠大小、直肠阴道瘘的位置和放置位置，以及接近阴道。组织的触觉条件类似于人体组织和手术条件。
考虑到儿科外科受训者和儿科外科医生在实践中对索引病例的接触减少，基于模拟的培训可以提供获得或维持执行复杂手术程序所需技能的手段[1-5]。用于 ARM 的手术模拟模型有限。为数不多的低成本培训器具有主要是人工的和大多数不现实的组织[6-8]。动物模型具有逼真的多层组织触觉反馈的优势[6]。
我们提供了一种低成本、高保真的模型，用于纠正 ARM 儿童的直肠阴道瘘，这是一种复杂的手术程序，发病率低但结果风险高。所描述的利用鸡泄殖腔解剖结构的组织模型为直肠阴道 ARM 的手术矫正提供了高保真模型。就 ARM 的治疗模拟目的而言，就提供儿科尺寸的真实病理和触觉反馈而言，该模型似乎很有前途。
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