Sanchez-Garcia Jorge, Lopez-Verdugo Fidel, Shorti Rami, Krong Jake, Zendejas Ivan, Contreras Alan G, Botha Jean, Rodriguez-Davalos Manuel I
Liver Transplant Service, Intermountain Primary Children's Hospital, Salt Lake City, UT.
Advanced Visualization Engineering, Intermountain Health, Salt Lake City, UT.
Transplant Direct. 2024 Aug 8;10(9):e1691. doi: 10.1097/TXD.0000000000001691. eCollection 2024 Sep.
In the United States, no published guidelines promote exposure to technical variants (ie, living donor or split liver) during transplant fellowship. Simulation with hands-on liver models may improve training in transplantation. This pilot study addressed 3 overall goals (material and model creation tools, recruitment rates and assessment of workload, and protocol adherence).
A patient-specific hands-on liver model was constructed from clinical imaging, and it needed to be resilient and realistic. Multiple types of materials were tested between January 2020 and August 2022. Participants were recruited stepwise. A left lateral segmentectomy simulation was conducted between August 2022 and December 2022 to assess protocol adherence.
Digital anatomy 3-dimensional printing was considered the best option for the hands-on liver model. The recruitment rate was 100% and 47% for junior attendings and surgical residents, respectively. Ten participants were included and completed all the required surveys. Seven (70%) and 6 (60%) participants "agreed" that the overall quality of the model and the material were acceptable for surgical simulation. Five participants (50%) "agreed" that the training improved their surgical skills. Nine participants (90%) "strongly agreed" that similar sessions should be included in surgical training programs.
Three-dimensional hands-on liver models have the advantage of tactile feedback and were rated favorably as a potential training tool. Study enrollment for further studies is possible with the support of leadership. Rigorous multicenter designs should be developed to measure the actual impact of 3-dimensional hands-on liver models on surgical training.
在美国,尚无已发表的指南提倡在移植 fellowship 期间接触技术变体(即活体供体或劈离式肝脏)。使用实体肝脏模型进行模拟可能会改善移植培训。这项初步研究涉及三个总体目标(材料和模型创建工具、招募率和工作量评估以及方案依从性)。
根据临床影像构建了一个患者特异性实体肝脏模型,该模型需要具有弹性且逼真。在2020年1月至2022年8月期间测试了多种材料。逐步招募参与者。在2022年8月至2022年12月期间进行了左外叶肝切除术模拟,以评估方案依从性。
数字解剖三维打印被认为是实体肝脏模型的最佳选择。初级主治医生和外科住院医师的招募率分别为100%和47%。纳入了10名参与者并完成了所有所需的调查。7名(70%)和6名(60%)参与者“同意”该模型的整体质量和材料对于手术模拟是可接受的。5名参与者(50%)“同意”该培训提高了他们的手术技能。9名参与者(90%)“强烈同意”手术培训项目应包括类似的课程。
三维实体肝脏模型具有触觉反馈的优势,作为一种潜在的培训工具获得了良好评价。在领导层的支持下,可以为进一步的研究进行研究招募。应制定严格的多中心设计,以衡量三维实体肝脏模型对手术培训的实际影响。