Xiaobo Wang1,2,3, Kunsong Zhang4, Wenjie Hu4, Ming Kuang4, Serene Teo5, Zhiyong Guo1,2,3, Qiang Zhao6,7,8, Xiaoshun He9,10,11. 1. Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China. 2. Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, 510080, People's Republic of China. 3. Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, 510080, People's Republic of China. 4. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China. 5. Faculty of Medicine, University of Glasgow, Glasgow, Scotland, UK. 6. Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China. 522511042@qq.com. 7. Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, 510080, People's Republic of China. 522511042@qq.com. 8. Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, 510080, People's Republic of China. 522511042@qq.com. 9. Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China. gdtrc@163.com. 10. Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, 510080, People's Republic of China. gdtrc@163.com. 11. Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, 510080, People's Republic of China. gdtrc@163.com.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Entities:
Keywords:
Laparoscopic training; Live; Multivisceral organs; Simulator; Specific events