Gallant Tara L, Lieng Monica K, Rizzo Jennifer L, Brandt James D, Lim Michele C
Department of Ophthalmology and Vision Sciences, University of California Davis Eye Center, Sacramento, California.
J Acad Ophthalmol (2017). 2023 Jun 19;15(1):e126-e131. doi: 10.1055/s-0043-1768919. eCollection 2023 Jan.
In an era when trabeculectomy surgeries in the United States are on the decline, ophthalmology residents may have limited opportunities to practice surgical techniques critical to success. However, key steps of trabeculectomy surgery can be introduced in a wet laboratory using a simple surgical model based on food items. A fresh lime and chicken parts with skin, purchased from a grocery store, were utilized to practice trabeculectomy surgery. The white rind of a lime was used as a surrogate for human sclera and was incised to create a trabeculectomy flap. The flap was then successfully sewn down with 10-0 nylon suture using an operating microscope. The skin of the chicken part was used to re-create a fornix-based and limbus-based conjunctival incision, which was then sutured closed using 6-0 Vicryl suture. A survey of wet laboratory participants was conducted to assess the feasibility and efficacy of this technique. Survey respondents were divided into two groups, those who had performed ≥40 incisional glaucoma surgeries and those who had performed <40. Both groups rated the simulation a 4 (mode) out of 5 in terms of how well it prepared them for glaucoma surgery on a human eye and how well the materials replicated human tissue, with 1 being not at all and 5 being very well. Similarly, both groups rated ease of setup and material acquisition a 1 out of 5, 1 being not difficult at all and 5 being extremely difficult. Also, 93.5% of the survey respondents recommended implementing this training model at other teaching hospitals, and none of the respondents recommended against it. This trabeculectomy teaching model is inexpensive, clean, and safe, and it provides a reasonably realistic substrate for surgical practice. It does not require cadaver or animal eyes, and no fixatives are needed, thus minimizing the risk of contact with biohazardous materials. Wet laboratory materials are easy to obtain, making this a practical model for practicing glaucoma surgery in both westernized and developing countries.
在美国小梁切除术手术量呈下降趋势的时代，眼科住院医师练习对手术成功至关重要的手术技巧的机会可能有限。然而，小梁切除术的关键步骤可以在湿实验室中通过使用基于食品的简单手术模型来介绍。
从杂货店购买的新鲜酸橙和带皮鸡肉用于练习小梁切除术。酸橙的白色外皮被用作人类巩膜的替代物，并切开以制作小梁切除瓣。然后使用手术显微镜用10-0尼龙缝线成功地将瓣缝合。鸡肉部分的皮肤用于重新制作穹窿部和角膜缘部结膜切口，然后用6-0薇乔缝线缝合关闭。对湿实验室参与者进行了一项调查，以评估该技术的可行性和有效性。
调查对象分为两组，一组是进行过≥40例切开性青光眼手术的人，另一组是进行过<40例切开性青光眼手术的人。两组在该模拟对他们进行人眼青光眼手术的准备程度以及材料对人体组织的复制程度方面，均将其评为5分制中的4分（众数），1分表示完全没有，5分表示非常好。同样，两组在设置和材料获取的难易程度方面均将其评为5分制中的1分，1分表示一点也不难，5分表示极其困难。此外，93.5%的调查对象建议在其他教学医院实施这种培训模式，没有调查对象表示反对。
这种小梁切除术教学模型价格低廉、干净且安全，为手术练习提供了相当逼真的基质。它不需要尸体或动物眼睛，也不需要固定剂，从而将接触生物危害材料的风险降至最低。湿实验室材料很容易获得，这使其成为在西方化国家和发展中国家练习青光眼手术的实用模型。
