Kazuhiro Endo, MD, Naohiro Sata, MD, PhD, Atsushi Miki, MD, PhD, Masaru Koizumi, MD, PhD, Hideki Sasanuma, Yasunaru Sakuma, Alan K Lefor, MD, MPH, PhD, FACS. Jichi Medical University
Introduction: The aim of this study is to develop a training box that replicates the human intra-abdominal environment with an organ model based on a surgical scenario.
Development of the training box: The training box has two parts, a rigid retroperitoneum and a soft anterior abdominal wall. We replicated the shape of the retroperitoneum using CT scan data. The anterior abdominal wall was designed by measuring the shape of a human abdominal wall with pneumoperitoneum, and created with soft materials.
Development of the organ model unit: We made a model for training in laparoscopic cholecystectomy. A standard surgical scenario for laparoscopic cholecystectomy was developed. Each step was delineated, confirming the tasks for each step. We determined the relevant organs and structures, factors determining the degree of difficulty, surgical instruments used, and potential pitfalls. The model replicates: gallbladder, cystic duct, common hepatic duct, common bile duct, right hepatic artery, cystic artery, liver, Rouviere’s sulcus, fatty tissue and the peritoneum. These were designed using CT and MRI data and surgical images with 3D computer assisted design. Polyvinyl chloride was used because the sensation of grasping, dissection and cutting could be replicated with forceps and an electrocautery.
Surgical training (Fig.1): Using this training box and organ model, the laparoscopic cholecystectomy procedure was simulated with real surgical devices. A mono-polar electrocautery was used to cut tissue. Blunt dissection was performed with forceps. The cystic duct and cystic artery were exposed and identified. A critical view of safety was created. It took approximately 20 min. to complete the simulation training for laparoscopic cholecystectomy.
Development of new surgical devices: For development of new devices, this replica of a human and organ model unit based on a surgical scenario provided useful evaluation and feedback for further development. This system facilitated communication between surgeons and engineers.
Conclusion: We developed a human-replica training box and organ model unit based on an actual surgical scenario.