收稿日期: 2017-01-24
网络出版日期: 2017-04-27
基金资助
广东省科技计划项目（2015A040404022，2014A020 212200，2015B010125005，2015B010125006），南方医院杰青培养计划(2016J007)
Construction and validation of a training model for laparoscopic partial nephrectomy using isolated porcine kidney
Received date: 2017-01-24
Online published: 2017-04-27
目的 应用离体猪肾构建模拟腹腔镜肾部分切除术培训模型，并对培训模型进行评价。 方法 将新鲜猪肾在肾纤维囊外去除脂肪等组织，在猪肾表面盖两个同心圆圈，小圈内径约28 mm，大圈32 mm，随后操作时将猪肾固定在人体塑料模型内。高级组6名、中级组6名、初级组8名进行腹腔镜下肾部分切除的操作，记录数据并进行统计分析。随后高级职称医师对模型进行Likert评分表评分，对离体猪肾解剖结构条件、操作质感、外观及颜色、模型总体的逼真情况等方面进行评价。 结果 Likert评分中，模型解剖条件为5.00±0.00；操作质感为4.33±0.52；外观及颜色为4.33±0.52；模型总体逼真情况为4.67±0.52。初、中、高级组人员在第一次肾部分切除术的肾脏部分切除时间、缝合时间、内外圈损伤数、缝合后切缘间隙距离等指标有统计学差异。 结论 此培训模型具有简便、经济、手术模拟逼真度高等优点，可用于腹腔镜肾部分切除的高级培训。
张辉见 , 胡正飞 , 彭鹏 , 孔祥雪 , 党强 , 杜冰冉 , 魏强 , 李鉴轶 . 基于离体猪肾的腹腔镜肾部分切除模型的构建及验证[J]. 中国临床解剖学杂志, 2017 , 35(2) : 199 -202 . DOI: 10.13418/j.issn.1001-165x.2017.02.016
Objective To constructa training model for laparoscopic partial nephrectomy (LPN)using isolated porcine kidney, as well as to evaluateits efficacy in LPN training. Methods Adipose and other tissues outer to the renal fascia were removed from the isolated porcine kidney. Two concentric circles with different diameters of 28 mm and 32 mm were placed on the surface of the porcine kidney, respectively. The trainees, including 6 experts, 6 intermediates and 8 novices, were asked to perform a LPN to evaluate the validity of the training model. The operative time,the suture time, the damage of two concentric circles, and the length of the wounds after suturewere recorded. Likert scale was used by 6 experts to evaluate the appearance, the anatomical structure, the operation texture, and the overall realistic simulation of the model. Results In Likert scale, quality assessment of the model for anatomical structure was 5.00±0.00, for appearance was 4.33±0.52, for operation texture was 4.33±0.52, and for overall realistic simulation was 4.67±0.52. There were significant differences among the three groups in operative time, suture time, damage of two concentric circles, and length of the wounds after suture (P<0.05). Conclusion The training model was suitable for advanced training of LPN with its advantages in simplicity, economy and high fidelity of operation simulation.
Key words： Partial nephrectomy; Laparoscopic surgery; Training model; Isolated organ
[1] Kumbla RA, Figlin RA, Posadas EM. Recent advances in the medical treatment of recurrent or metastatic renal cell cancer [J].Drugs, 2016,19(11):342-347.
[2] Zhao PT, Richstone L, Kavoussi LR. Laparoscopic partial nephrectomy [J]. Int J Surg, 2016, 36:548-553.
[3] Khosla A, Wagner AA. Robotic surgery of the kidney, bladder, and prostate [J]. Surg Clin North Am, 2016, 96(3):615-636.
[4] 李云，杨波，曾钦松，等. 应用离体猪肾构造腹腔镜下肾部分切除术的培训模型[J].第二军医大学学报，2012, 33(6):650-653.
[5] Tyson MD, Humphreys MR. Urological applications of natural orifice transluminal endoscopic surgery (NOTES) [J]. Nat Rev Urol, 2014,11(6):324-332.
[6] Conover WJ. Practical Nonparametric Statistics[M]. Second Edition. New York: John Wiley and Sons,1980:231.
[7] Beyer-Berjot L, Palter V, Grantcharov T, et al. Advanced training in laparoscopic abdominal surgery: a systematic review [J]. Surgery, 2014,156(3):676-688.
[8] Torricelli FC, Barbosa JA, Marchini GS. Impact of laparoscopic surgery training laboratory on surgeon's performance [J]. World J Gastrointest Surg, 2016, 8(11):735-743.
[9] Raque J, Billeter AT, Lucich E, et al. Training techniques in laparoscopic donor nephrectomy: a systematic review[J]. Clin Transplant, 2015, 29(10):893-903.
[10] Jalink MB, Goris J, Heineman E, et al. The effects of video games on laparoscopic simulator skills [J]. Am J Surg, 2014, 208(1):151-156.
[11]Alaker M, Wynn GR, Arulampalam T. Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis[J]. Int J Surg, 2016, 5(29):85-94.
[12] Willaert W, Van De Putte D, Van Renterghem K, et al.Training models in laparoscopy: a systematic review comparing their effectiveness in learning surgical skills[J]. Acta Chir Belg, 2013, 113(2):77-95.
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