Department of Hepatopancreaticobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
J Robot Surg. 2024 Nov 5;18(1):394. doi: 10.1007/s11701-024-02151-x.
In the era of minimally invasive surgery (MIS), parenchyma-preserving liver resections are gaining prominence with the potential to offer improved perioperative outcomes without compromising oncological safety. The surgeon learning curve remains challenging, and simulation plays a key role in surgical training. Existing simulation models can be limited by suboptimal fidelity and high cost. We describe a novel, reproducible, high-fidelity, low-cost liver metastases model using porcine livers from adult Landrace pigs, with porcine perinephric fat used to simulate subcapsular metastases. This model was then utilised in a training session for surgical trainees performing robotic parenchyma-preserving surgery (PPS) under the guidance of expert robotic surgeons, with feedback being recorded. Trainees rated the model highly on its fidelity to human liver simulation (median score 9), tissue handling (median score 8), and overall usefulness (median score 9). Tissue handling was felt to simulate in vivo liver resection closely, while suggestions for improvement included adding simulated blood flow. This is a novel, low-cost, high-fidelity simulation model of liver metastases with high acceptability to surgical trainees, which could be readily adopted by other training centres.
在微创手术（MIS）时代，保留肝实质的肝切除术越来越受到关注，它有可能在不影响肿瘤安全性的情况下改善围手术期结果。外科医生的学习曲线仍然具有挑战性，模拟在外科培训中起着关键作用。现有的模拟模型可能存在保真度不理想和成本高的问题。我们使用来自成年长白猪的猪肝脏描述了一种新颖的、可重现的、高保真度的、低成本的肝转移模型，使用猪肾周脂肪模拟包膜下转移。然后，该模型被用于在机器人专家的指导下，对接受机器人辅助保留肝实质手术（PPS）培训的外科医生进行培训，记录反馈。受训者对该模型在模拟人肝方面的逼真度（中位数为 9）、组织处理（中位数为 8）和整体有用性（中位数为 9）的评价很高。他们认为该模型非常逼真地模拟了活体肝切除术，同时也提出了一些改进建议，包括添加模拟血流。这是一种新颖的、低成本的、高保真度的肝转移模拟模型，深受外科医生的欢迎，其他培训中心也可以很容易地采用这种模型。
