Skip to main content
SpringerLink
Log in

Novel laparoscopic training system with continuously perfused ex-vivo porcine liver for hepatobiliary surgery

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Objective

To introduce a novel laparoscopic training system with a continuously perfused ex-vivo porcine liver for hepatobiliary surgery.

Background

Existing models for laparoscopic training, such as box trainers and virtual reality simulators, often fail to provide holistic training and real haptic feedback. We have formulated a new training system that addresses these problems.

Methods

Real-Liver Laptrainer consists of a porcine liver, customized mannequin, ex-vivo machine perfusion system, and monitoring software. We made a detailed comparison of Real-Liver Laptrainer with the LapSim virtual reality simulator and the FLS Trainer Box systems. Five laparoscopic surgeons assessed the new system on multiple features. We assessed the performances of 43 trainees who used the new system to perform laparoscopic cholecystectomy (LC) three times.

Results

Real-Liver Laptrainer offered more functions and better tactile feedback than the FLS or LapSim system. All five surgeons graded the quality of the new system as realistic. The utility of the system for training was scored as 3.6 ± 1.1 on a scale of 1–5. Between the first and third attempts, the number of successfully performed LCs increased (9 vs 14 vs 23; P = .011), while the numbers of liver damage incidents (25 vs. 21 vs. 18, P = .303) and gallbladder perforations decreased (17 vs. 12 vs. 9, P = .163). The mean LC operation time significantly decreased (63 vs. 50 vs. 44, P < .0001).

Conclusion

Real-Liver Laptrainer is a feasible, stable, and practical training model that has potential for improving the laparoscopic skills of surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hendolin HI, Paakonen ME, Alhava EM, Tarvainen R, Kemppinen T, Lahtinen P (2000) Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response. Eur J Surg 166:394–399

    Article  CAS  PubMed  Google Scholar 

  2. Lee JH, Yom CK, Han HS (2009) Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 23:1759–1763

    Article  PubMed  Google Scholar 

  3. Crothers IR, Gallagher AG, McClure N, James DT, McGuigan J (1999) Experienced laparoscopic surgeons are automated to the “fulcrum effect”: an ergonomic demonstration. Endoscopy 31:365–369

    Article  CAS  PubMed  Google Scholar 

  4. Perkins N, Starkes JL, Lee TD, Hutchison C (2002) Learning to use minimal access surgical instruments and 2-dimensional remote visual feedback: how difficult is the task for novices? Adv Health Sci Educ Theory Pract 7:117–131

    Article  PubMed  Google Scholar 

  5. Stefanidis D, Scerbo MW, Korndorffer JR Jr, Scott DJ (2007) Redefining simulator proficiency using automaticity theory. Am J Surg 193:502–506

    Article  PubMed  Google Scholar 

  6. Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A (2004) Laparoscopic virtual reality and box trainers: is one superior to the other? Surg Endosc 18:485–494

    Article  CAS  PubMed  Google Scholar 

  7. Dunkin B, Adrales GL, Apelgren K, Mellinger JD (2007) Surgical simulation: a current review. Surg Endosc 21:357–366

    Article  CAS  PubMed  Google Scholar 

  8. Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM (2005) Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 241:364–372

    Article  PubMed  PubMed Central  Google Scholar 

  9. Seymour NE (2008) VR to OR: a review of the evidence that virtual reality simulation improves operating room performance. World J Surg 32:182–188

    Article  PubMed  Google Scholar 

  10. Rassweiler J, Klein J, Teber D, Schulze M, Frede T (2007) Mechanical simulators for training for laparoscopic surgery in urology. J Endourol Soci 21:252–262

    Article  Google Scholar 

  11. Schijven M, Jakimowicz J (2003) Virtual reality surgical laparoscopic simulators. Surg Endosc 17:1943–1950

    Article  CAS  PubMed  Google Scholar 

  12. Dankelman J (2008) Surgical simulator design and development. World J Surg 32:149–155

    Article  PubMed  Google Scholar 

  13. Velazquez-Avina J, Sobrino-Cossio S, Chavez-Vargas C, Sulbaran M, Monkemuller K (2014) Development of a novel and simple ex vivo biologic ERCP training model. Gastrointest Endosc 80:1161–1167

    Article  PubMed  Google Scholar 

  14. Vapenstad C, Hofstad EF, Bo LE, Chmarra MK, Kuhry E, Johnsen G, Marvik R, Lango T (2013) Limitations of haptic feedback devices on construct validity of the LapSim(R) virtual reality simulator. Surg Endosc 27:1386–1396

    Article  PubMed  Google Scholar 

  15. Vapenstad C, Hofstad EF, Lango T, Marvik R, Chmarra MK (2013) Perceiving haptic feedback in virtual reality simulators. Surg Endosc 27:2391–2397

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors want to thank all medical students and surgeons for their participation in all trials and the staff at Institute of Advanced Surgical Technology and Engineering of the First Affiliated Hospital of Xi’an Jiaotong University for the help and facilities to carry out this study.

Author information

Authors and Affiliations

  1. Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China

    Wenyan Liu, Xinglong Zheng, Rongqian Wu, Jianpeng Li, Jianwen Lu, Huan Yang, Xianghua Xu, Yi Lv & Xiaogang Zhang

  2. College of Electrical Engineering, Xi’an Jiaotong University, Xi’an, People’s Republic of China

    Yinbin Jin

  3. Institute of Medical Engineering, Medical School of Xi’an Jiaotong University, Xi’an, People’s Republic of China

    Shu Kong

Authors
  1. Wenyan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xinglong Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rongqian Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yinbin Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shu Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jianpeng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianwen Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Huan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xianghua Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yi Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Xiaogang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yi Lv or Xiaogang Zhang.

Ethics declarations

Disclosures

This study was supported by a grant from the National Natural Science Foundation of Equipment awarded to Yi Lv (Grant No. 81127005). Wenyan Liu, Xinglong Zheng, Rongqian Wu, Yinbin Jin, Shu Kong, Jianpeng Li, Jianwen Lu, Huan Yang, Xianghua Xu, Yi Lv, and Xiaogang Zhang have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, W., Zheng, X., Wu, R. et al. Novel laparoscopic training system with continuously perfused ex-vivo porcine liver for hepatobiliary surgery. Surg Endosc 32, 743–750 (2018). https://doi.org/10.1007/s00464-017-5731-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5731-6

Keywords

Search

Navigation