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An ex vivo liver training model continuously perfused to simulate bleeding for suture skills involved in laparoscopic liver resection: development and validity

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Abstract

Background

Suture skills are essential to laparoscopic liver resection. The current suture training models are not ideal enough. The aim of this study is to develop and verify a highly simulated-bleeding continuously perfused training model (CPTM) and to evaluate its training efficacy.

Methods

CPTM was constructed using fresh lamb liver whose portal veins were perfused with red-dyed liquid gelatin. Construct validity of CPTMs was tested in 33 participants with three levels of laparoscopic experience (experts, intermediates, and novices) who were demanded to finish one superficial stitch and one deep stitch for suture hemostasis on CPTMs. The CPTMs were also evaluated by the experts. CPTMs were compared with dry box training models (DBTMs) regarding training efficacy among the novices who were assigned to DBTM and CPTM groups to, respectively, complete a 10-day training on CPTMs or DBTMs. Before and after their assignments, their superficial stitches were assessed by completion time, suture accuracy, and suture knot performance while their deep stitches by completion time and bleeding control.

Results

CPTM proved to be construct valid by both superficial and deep stitches. Significant differences were found regarding completion time (763, 271, 174 s), suture accuracy (4.4, 1.8, 0.2 mm), and suturing knot performance (12.1, 21.5, 22.0) for superficial stitches (p < 0.001), as well as regarding completion time (807, 423, 277 s) for deep stitches (p < 0.001). Positive comments were given by all experts. CPTMs helped novices to acquire laparoscopic suture skills. Their training efficacy was significantly better than that of DBTMs (p < 0.05). Learning curves of CPTM group plateaued at the sixth round for superficial stitches and at the seventh round for deep stitches.

Conclusion

CPTM offers trainees a highly simulated-bleeding means to acquire advanced laparoscopic suture skills. The suture skills learned on CPTMs may improve significantly at the seventh round.

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References

  1. Chang SK, Lee CS, Hlaing WW et al (2011) Vascularised porcine liver model for surgical training. Med Educ 45:520

    Article  PubMed  Google Scholar 

  2. Otsuka Y, Kaneko H, Cleary SP et al (2015) What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd international consensus conference on laparoscopic liver resection. J Hepatobiliary Pancreat Sci 22:363–370

    Article  PubMed  Google Scholar 

  3. Sarpel U, Ayo DM, Newman E (2012) Choice of device for parenchymal transection in laparoscopic hepatectomy. Surg Technol Int 22:33–38

    PubMed  Google Scholar 

  4. Ieiri S, Ishii H, Souzaki R et al (2013) Development of an objective endoscopic surgical skill assessment system for pediatric surgeons: suture ligature model of the crura of the diaphragm in infant fundoplication. Pediatr Surg Int 29:501–504

    Article  PubMed  Google Scholar 

  5. Romero P, Brands O, Nickel F et al (2014) Intracorporal suturing—driving license necessary? J Pediatr Surg 49:1138–1141

    Article  CAS  PubMed  Google Scholar 

  6. Gomez PP, Willis RE, Schiffer BL et al (2014) External validation and evaluation of an intermediate proficiency-based knot-tying and suturing curriculum. J Surg Educ 71:839–845

    Article  PubMed  Google Scholar 

  7. Scott DJ, Goova MT, Tesfay ST (2007) A cost-effective proficiency-based knot-tying and suturing curriculum for residency programs. J Surg Res 141:7–15

    Article  PubMed  Google Scholar 

  8. Huang E, Chern H, O’Sullivan P et al (2014) A better way to teach knot tying: a randomized controlled trial comparing the kinesthetic and traditional methods. Am J Surg 208:690–694

    Article  PubMed  Google Scholar 

  9. Goova MT, Hollett LA, Tesfay ST et al (2008) Implementation, construct validity, and benefit of a proficiency-based knot-tying and suturing curriculum. J Surg Educ 65:309–315

    Article  PubMed  Google Scholar 

  10. Causer J, Vickers JN, Snelgrove R et al (2014) Performing under pressure: quiet eye training improves surgical knot-tying performance. Surgery 156:1089–1096

    Article  PubMed  Google Scholar 

  11. Rodrigues SP, Horeman T, Blomjous MS et al (2015) Laparoscopic suturing learning curve in an open versus closed box trainer. Surg Endosc 30:315–322

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wang H, Yang B, Xu C et al (2009) New practical course for laparoscopy training: anatomizing the orange. Eur Surg Res 42:106–108

    Article  CAS  PubMed  Google Scholar 

  13. Wong IH, Denkers M, Urquhart N et al (2013) Construct validity testing of the Arthroscopic Knot Trainer (ArK). Knee Surg Sports Traumatol Arthrosc 23:906–911

    Article  PubMed  Google Scholar 

  14. Wong J, Bhattacharya G, Vance SJ et al (2013) Construction and validation of a low-cost laparoscopic simulator for surgical education. J Surg Educ 70:443–450

    Article  PubMed  Google Scholar 

  15. Santos BF, Reif TJ, Soper NJ et al (2012) Development and evaluation of a laparoscopic common bile duct exploration simulator and procedural rating scale. Surg Endosc 26:2403–2415

    Article  PubMed  Google Scholar 

  16. Van Sickle KR, Ritter EM, Baghai M et al (2008) Prospective, randomized, double-blind trial of curriculum-based training for intracorporeal suturing and knot tying. J Am Coll Surg 207:560–568

    Article  PubMed  Google Scholar 

  17. Dehabadi M, Fernando B, Berlingieri P (2014) The use of simulation in the acquisition of laparoscopic suturing skills. Int J Surg 12:258–268

    Article  PubMed  Google Scholar 

  18. Korndorffer JJ, Dunne JB, Sierra R et al (2005) Simulator training for laparoscopic suturing using performance goals translates to the operating room. J Am Coll Surg 201:23–29

    Article  PubMed  Google Scholar 

  19. Strickland A, Fairhurst K, Lauder C et al (2011) Development of an ex vivo simulated training model for laparoscopic liver resection. Surg Endosc 25:1677–1682

    Article  PubMed  Google Scholar 

  20. Munz Y, Almoudaris AM, Moorthy K et al (2007) Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality. Am J Surg 193:774–783

    Article  PubMed  Google Scholar 

  21. Laird A, Stewart GD, Hou S et al (2011) A novel bovine model for training urological surgeons in laparoscopic radical nephrectomy. J Endourol 25:1377–1383

    Article  PubMed  Google Scholar 

  22. Stolzenburg J, Truss MC, Rabenalt R et al (2007) Training in laparoscopy. EAU-EBU Update Ser 5:53–62

    Article  Google Scholar 

  23. Aggarwal R, Crochet P, Dias A et al (2009) Development of a virtual reality training curriculum for laparoscopic cholecystectomy. Br J Surg 96:1086–1093

    Article  CAS  PubMed  Google Scholar 

  24. Teh SH, Hunter JG, Sheppard BC (2007) A suitable animal model for laparoscopic hepatic resection training. Surg Endosc 21:1738–1744

    Article  PubMed  Google Scholar 

  25. Szinicz G, Beller S, Bodner W et al (1993) Simulated operations by pulsatile organ-perfusion in minimally invasive surgery. Surg Laparosc Endosc 3:315–317

    Article  CAS  PubMed  Google Scholar 

  26. Yang B, Zeng Q, Yinghao S et al (2009) A novel training model for laparoscopic partial nephrectomy using porcine kidney. J Endourol 23:2029–2033

    Article  PubMed  Google Scholar 

  27. Nam SM, Shin HS, Kim YB et al (2013) Microsurgical training with porcine thigh infusion model. J Reconstr Microsurg 29:303–306

    Article  PubMed  Google Scholar 

  28. Tang B, Tait I, Ross G et al (2011) Development and use of a restructured animal tissue model for training in laparoscopic salpingostomy and salpingectomy. J Minim Invasive Gynecol 18:785–791

    Article  PubMed  Google Scholar 

  29. Cheung CL, Looi T, Lendvay TS et al (2014) Use of 3-dimensional printing technology and silicone modeling in surgical simulation: development and face validation in pediatric laparoscopic pyeloplasty. J Surg Educ 71:762–767

    Article  PubMed  Google Scholar 

  30. Zhang A, Hunerbein M, Dai Y et al (2008) Construct validity testing of a laparoscopic surgery simulator (Lap Mentor): evaluation of surgical skill with a virtual laparoscopic training simulator. Surg Endosc 22:1440–1444

    Article  PubMed  Google Scholar 

  31. McDougall EM, Corica FA, Boker JR et al (2006) Construct validity testing of a laparoscopic surgical simulator. J Am Coll Surg 202:779–787

    Article  PubMed  Google Scholar 

  32. Shanmugan S, Leblanc F, Senagore AJ et al (2014) Virtual reality simulator training for laparoscopic colectomy: what metrics have construct validity? Dis Colon Rectum 57:210–214

    Article  PubMed  Google Scholar 

  33. Sanchez-Peralta LF, Sanchez-Margallo FM, Moyano-Cuevas JL et al (2010) Construct and face validity of SINERGIA laparoscopic virtual reality simulator. Int J Comput Assist Radiol Surg 5:307–315

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank all the volunteers involved in this study. We also thank Professor Liang Allen Ping from School of Foreign Studies of Southern Medical University for revising the manuscript.

Funding

This work was supported by National Natural Science Foundation of China (61190122, 61190123) and Science and Technology Research Program of Guangzhou and Guangdong ([2011]233-39, 2013B021800179).

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    Authors and Affiliations

    1. Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, China

      Jujiao Xiao, Maoqing Fu, Xiangxue Kong, Lei Tang, Zhanglin Wang, Fuyu You & Jianyi Li

    2. Department of General Surgery, Zhongshan Guzhen People’s Hospital, Zhongshan, Guangdong, China

      Jujiao Xiao

    3. Department of Hepatobiliary Surgery, NanFang Hospital, Southern Medical University, Guangzhou, China

      Zhonglin Cui

    4. Training Center of Clinical Skills, NanFang Hospital, Southern Medical University, Guangzhou, China

      Qingfeng Du

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    Correspondence to Qingfeng Du or Jianyi Li.

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    Jujiao Xiao, Zhonglin Cui, Maoqing Fu, Xiangxue Kong, Lei Tang, Zhanglin Wang, Fuyu You, Qingfeng Du, and Jianyi Li have no conflicts of interest or financial ties to disclose.

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    Jujiao Xiao and Zhonglin Cui have contributed equally to this work.

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    Xiao, J., Cui, Z., Fu, M. et al. An ex vivo liver training model continuously perfused to simulate bleeding for suture skills involved in laparoscopic liver resection: development and validity. Surg Endosc 30, 4553–4561 (2016). https://doi.org/10.1007/s00464-016-4792-2

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