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An Ex Situ Cadaver Liver Training Model Continuously Pressurized to Simulate Specific Skills Involved in Laparoscopic Liver Resection: the Lap-Liver Trainer

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Journal of Gastrointestinal Surgery

Abstract

Background

Laparoscopic liver resection (LLR) requires delicate skills. The aim of the study was to develop a training model mimicking as much as possible intraoperative bleeding and bile leakage during LLR. We also assessed the educational value of the training model.

Methods

The Lap-liver trainer (LLT) combined a continuously pressurized ex situ cadaver liver and a customized mannequin. The customized mannequin was designed by computer-aided design and manufactured by 3D printing. The left lateral sectionectomy (LLS) was chosen to assess the feasibility of a LLR with the LLT. Eighteen volunteers were recruited to perform LLS and to assess the educational value of the LLT using a Likert scale.

Results

The customized mannequin consisted of a close laparoscopic training device based on a simplified reconstruction of the abdominal cavity in laparoscopic conditions. Ex situ cadaver livers were pressurized to simulate blood and bile supplies. Each expert surgeon (n = 3) performed two LLS. They were highly satisfied of simulation conditions (4.80 ± 0.45) and strongly recommended that the LLT should be incorporated into a teaching program (5.00 ± 0.0). Eight novice and 4 intermediate surgeons completed a teaching program and performed a LLS. Overall, the level of satisfaction was high (4.92 ± 0.29), and performing such a procedure under simulation conditions benefited their learning and clinical practice (4.92 ± 0.29).

Conclusions

The LLT could provide better opportunities for trainees to acquire and practice LLR skills in a more realistic environment and to improve their ability to deal with specific events related to LLR.

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Data Availability

The data that support the findings of this study are available from the corresponding author, Pierre-Guillaume CHAMPAVIER, and can be provided upon reasonable request.

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Authors and Affiliations

  1. Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France

    Pierre-Guillaume Champavier, Laura Beyer-Berjot, Pierre-Jean Arnoux, Max Py, Stéphane Berdah & Théophile Guilbaud

  2. Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France

    Laura Beyer-Berjot, Stéphane Berdah, David Jérémie Birnbaum & Théophile Guilbaud

  3. Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France

    Laura Beyer-Berjot, Stéphane Berdah, David Jérémie Birnbaum & Théophile Guilbaud

  4. Aix-Marseille Univ, CNRS, ISM, Marseille, France

    Rémy Casanova

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  1. Pierre-Guillaume Champavier
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Contributions

Pierre-Guillaume Champavier: Conception and design of the work and acquisition of data. Drafted and revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Laura Beyer-Berjot: Conception and design of the work, analysis, and interpretation of data. Drafted and revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Pierre-Jean Arnoux: conception and design of the work. Revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Max Py: Conception and design of the work. Revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Remy Casanova: Acquisition of data. Revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Stéphane Berdah: Conception and design of the work. Revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

David Jérémie Birnbaum: Conception and design of the work, acquisition of data. Revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Théophile Guilbaud: Conception and design of the work, analysis, and interpretation of data. Drafted and revised the work. Final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Pierre-Guillaume Champavier.

Ethics declarations

The present liver training model named lap-liver trainer was patented under application number FR2200286 on 2022/01/14.

Competing Interests

The authors declare no competing interests.

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Supplementary Information

Below is the link to the electronic supplementary material.

Video the Lap-Liver Trainer in use. The first part presents the learning environment in CERC with a novice practicing LLS, and the second one presents the different LLS’ steps inside the model (performed by an expert surgeon). (MOV 260087 kb)

Supplementary figure 2.

Usability of the ex-situ pressurized cadaver liver for surgical training, assessment of intraparenchymal vascular permeability and efficacy of surgical devices for parenchymal transection. A. wedge resection of segment 6 showing permeability of the peripheral sub capsular micro vascularization (red arrow). B. Anterior aspect of ex-situ cadaver liver, the parenchymal transection plan was begun at the left side of the round and falciform ligaments (yellow area). C. The hepatic parenchymal transection was done with laparoscopic devices, allowing control of the Glissonian pedicle of segment 3 (a) and hepatic vein (b). D. End of the LLS, parenchymal transection plan checking and showing ligation of Glissonian pedicles, and the left hepatic vein (d). (PNG 559 kb)

High resolution image (TIFF 726 kb)

Supplementary figure 3.

Simulation of specific adverse events related to laparoscopic liver resection. A. Hemorrhage during liver parenchymal transection B. hemostasis of the liver parenchyma using bipolar coagulation. C. bile leakage. D. bile leakage control using laparoscopic metallic clips. (PNG 450 kb)

High resolution image (TIFF 596 kb)

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Champavier, PG., Beyer-Berjot, L., Arnoux, PJ. et al. An Ex Situ Cadaver Liver Training Model Continuously Pressurized to Simulate Specific Skills Involved in Laparoscopic Liver Resection: the Lap-Liver Trainer. J Gastrointest Surg 27, 521–533 (2023). https://doi.org/10.1007/s11605-022-05566-9

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