Y Isobe, MD, PhD1, Y Nishihara1, A Shibuya1, Y Sekimoto1, T Kondo1, Y Kawguchi1, J Tokuyama1, H Urakami1, K Omoto1, S Seki1, T Ohishi1, S Matsumoto1, K Yamamoto2, H Kanazawa3, G Kaneda3. 1National Hospital Organization Tokyo Medical Center, 2National Hospital Organization Chiba Medical Center, 3Sagamihara National Hospital
Objective: Simulation training for laparoscopic surgery has been widely performed to improve safety and shorten learning curves of the surgery. However, few surgical training simulators provide characteristics of laparoscopic surgery including anatomical reality, tactile sensation and difficulty in handling forceps and devices under the endoscopic view. Since 2014, we have innovated 3D-modeling training simulators of laparoscopic surgery. To simulate laparoscopic surgery more practically and instructively, we developed novel synthetic peritoneal tissue to enable preperitoneal tissue dissection and suturing.
Description of the technology and methods: As a simulation training program, trans-abdominal preperitoneal hernia repair (TAPP) was adopted, because TAPP requires basic skills of laparoscopic surgery and seems a gateway to a laparoscopic surgeon for novices. Mock peritoneum and preperitoneal soft tissue was made of hydrated polyvinyl alcohol. The proportion of water content was adjusted to imitate human body. Two-way crossing fine fibers were put within the synthetic peritoneum to keep strength and elasticity. This mock peritoneum was well attached to the urethane-made inguinal basis with surgical landmarks. Then this inguinal hernia model was set within a full-size laparoscopic surgical simulator produced using Bio-Texture Modeling (R) technique, which we have previously reported. The abdominal wall of the simulator was cast by 3D-printer using CT data of volunteers. Anterior abdominal wall was designed as a pneumo-peritoneal condition and made of soft and restoring material. The inguinal basis was reusable, and the mock peritoneum could be exchange for every simulation to save the training costs. This simulation system was co-developed with FASOTEC Co., Ltd and SUNARROW LIMITED, Japan. Simulation training was performed by handling equivalent devices and laparoscope for clinical use. The utility of the simulation was evaluated by a questionnaire for the trainees and instructors of the training.
Results: A series of TAPP surgery including peritoneal cutting, preperitoneal blunt dissection, parietalization of the testicular cord, laying and tacking a mesh and peritoneal closure could be well simulated. This training model could reproduce the difficult feeling of real surgery in dissecting preperitoneal tissue. This integrated and high-end training simulator was appreciated to be suitable for the scenario training of a novice surgeon just before a debut as an operator.
Conclusion: Our novel synthetic peritoneum improved quality of laparoscopic simulation training. It would help shorten learning curves of peritoneal and retroperitoneal surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91284
Program Number: ETP853
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster