Leishman David J, Oppler Scott H, Graham Melanie L, Jahansouz Cyrus
Preclinical Research Center, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, USA.
Ann Transl Med. 2024 Oct 20;12(5):93. doi: 10.21037/atm-24-25. Epub 2024 Aug 14.
Laparoscopic colon surgery is performed frequently in the clinical setting for a multitude of reasons including cancer, infection, and autoimmune disease. As a result, extensive research has been conducted in relation to clinical outcomes after surgery, but more recently, in relation to the impact of surgery and other patient factors on physiologic homeostasis including the host microbiome. Despite this, experimental surgical models for laparoscopic colon surgery are scarce in the literature with most studies utilizing rodents. While rodent studies provide valuable insights into basic mechanistic processes, the translation of novel therapeutic approaches to clinical practice often requires the use of large animal models. In exploring the intricate systems biology linking surgery and medicine, sophisticated models such as nonhuman primates (NHPs) play a pivotal role. By closely resembling human anatomical, physiological, and behavioral characteristics, NHPs facilitate the development and refinement of complex surgical techniques and peri-operative practices. Furthermore, they enable longitudinal studies that comprehensively assess both immediate and long-term outcomes. The availability and utilization of multiple robust models enhance the validity of surgical research, leading to more successful translation to human clinical practice. Here we describe our technique for performing a laparoscopic sigmoid colectomy with a primary anastomosis in an NHP. The entire procedure was well tolerated without significant ventilation or hemodynamic issue. To our knowledge, this represents the first laparoscopic sigmoid colectomy with primary anastomosis performed in an NHP. Furthermore, this demonstrates the feasibility of the technique and provides a relevant, preclinical model for the study of surgical colon disease. Although the surgical colectomy model in NHPs closely resembles the clinical scenario, it is crucial to recognize that a 'model' inherently comes with limitations. The intended use of any model should be carefully evaluated concerning the target patient population with the consideration of potential disparities in anatomy, physiology, environmental factors, and disease to properly interpret results. This model provides an opportunity to study mechanisms, from a systems biology perspective, underlying both innovative surgical treatments and their effects on diseases such as colon cancer, as well as benign conditions like inflammatory bowel disease, diverticulitis, and anastomotic leak, offering high predictive value.
由于多种原因，包括癌症、感染和自身免疫性疾病，腹腔镜结肠手术在临床环境中经常进行。因此，已经针对手术后的临床结果进行了广泛研究，但最近，也针对手术和其他患者因素对生理稳态（包括宿主微生物群）的影响进行了研究。尽管如此，文献中腹腔镜结肠手术的实验性手术模型却很稀缺，大多数研究使用啮齿动物。虽然啮齿动物研究为基本机制过程提供了有价值的见解，但将新的治疗方法转化为临床实践通常需要使用大型动物模型。在探索将手术与医学联系起来的复杂系统生物学时，诸如非人类灵长类动物（NHP）等复杂模型发挥着关键作用。通过与人类解剖学、生理学和行为特征极为相似，NHP有助于复杂手术技术和围手术期实践的开发与完善。此外，它们还能进行纵向研究，全面评估即时和长期结果。多种强大模型的可用性和利用提高了手术研究的有效性，从而使向人类临床实践的转化更加成功。在此，我们描述了在NHP中进行腹腔镜乙状结肠切除术并一期吻合的技术。整个手术过程耐受性良好，没有明显的通气或血流动力学问题。据我们所知，这是首次在NHP中进行的腹腔镜乙状结肠切除术并一期吻合。此外，这证明了该技术的可行性，并为研究手术性结肠疾病提供了一个相关的临床前模型。尽管NHP中的手术结肠切除术模型与临床情况极为相似，但必须认识到，“模型”本身存在局限性。对于任何模型的预期用途，都应针对目标患者群体仔细评估，同时考虑解剖学、生理学、环境因素和疾病方面的潜在差异，以便正确解释结果。该模型提供了一个机会，从系统生物学角度研究创新手术治疗及其对结肠癌等疾病以及炎症性肠病、憩室炎和吻合口漏等良性疾病的影响机制，具有很高的预测价值。
