已经开发了用于腹腔镜训练的各种训练模型。包括尸体在内的无生命模型,离体模拟器,虚拟现实(VR)不太现实,通常无法显示特定事件,如出血,胆漏,等。动物模型提供更真实的体验,但是像成本这样的限制,麻醉需求,和道德批准限制了它的应用。我们设计了一种新的训练离体模拟器-Smagister来解决这些问题。
Smagister由一个常温机灌注平台组成,猪腹腔多内脏器官(肝脏,胆囊,胰腺,胃,肠,肾,子宫,膀胱,等。),高清显示屏,和软件系统。记录血气分析和每小时蠕动次数。使用问卷每小时主观评估器官簇的活力。三种腹腔镜手术,包括胆囊切除术(LC),在Smagister上进行了肠切开术闭合(LEC)和肝切除术(LLR),演示每个程序的特定事件。六位专家在完成程序的可行性和并发症的演示方面将程序与实际手术进行了比较。
灌注液葡萄糖(6.1-8.2mmol/L)和乳酸(5.82-6.55mmol/L)的波动表明多内脏器官的代谢功能。平均蠕动次数为2.2/min。模拟的手术视图和解剖结构与连续灌注期间的实际手术非常相似(分别为3.5±1.0、3.8±0.8)。触觉反馈的评估得分为3.8±0.8,类似于活体组织处理。LC,LEC,LLR在Smagister上表现良好,清楚地显示特定的事件。所有六位专家都认为Smagister是基础和高级腹腔镜手术的合适培训方式。
Smagister中活体动物模型和离体模拟的融合集中了两种模式的优点,扩大培训领域,并为新手和高级外科医生提供高保真腹腔镜培训。
Various training models have been developed for laparoscopic training. Inanimate models including cadavers, ex-vivo simulator, and virtual reality (VR), are less realistic and often fail to display specific events such as bleeding, bile leakage, etc. Animal models provide more realistic experience, but constraints like cost involved, anesthetic requirement, and ethical approval have limited its application. We have designed a new training ex-vivo simulator-Smagister to address these issues.
The Smagister consists of a normothermic machine perfusion platform, multivisceral organ of porcine abdominal cavity (liver, gallbladder, pancreas, stomach, intestine, kidney, uterus, bladders, etc.), high-definition display, and software system. Blood gas analysis and number of peristalsis per hour were recorded. A questionnaire was used to subjectively assess vitality of the organ cluster every hour. Three laparoscopic procedures including cholecystectomy (LC), enterotomy closure (LEC) and hepatectomy (LLR) were performed on Smagister, with demonstration of specific events for each procedure. Six experts compared the procedures with actual surgery in terms of feasibility to complete procedures and demonstration of complications.
The fluctuation of perfusate glucose (6.1-8.2 mmol/L) and lactate (5.82-6.55 mmol/L) suggested metabolic function of the multivisceral organs. The mean number of peristalsis was 2.2/min. The simulated surgical view and anatomic structures closely resembled actual surgery during continuous perfusion (3.5 ± 1.0, 3.8 ± 0.8, respectively). The evaluation scores of haptic feedbacks were 3.8 ± 0.8, resembling
live tissue handling. LC, LEC, and LLR were performed well on the Smagister, with clear display of the specific events. All six experts considered Smagister as a suitable training modality for both basic and advanced laparoscopic surgery.
The amalgamation of
live animal model and ex-vivo simulation in Smagister centralizes the virtue of both modalities, expands the training field, and provides high-fidelity laparoscopic training for both novice and senior surgeons.