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中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 277 -283. doi: 10.3877/cma.j.issn.1674-3253.2024.03.014

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腹腔镜肾部分切除术离体猪肾培训模型的构建
张子旭1, 郑俊炯2, 罗云3, 林天歆2,()   
  1. 1. 510120 广州,中山大学孙逸仙纪念医院泌尿外科;230041 合肥,中国人民武装警察部队安徽省总队医院泌尿外科
    2. 510120 广州,中山大学孙逸仙纪念医院泌尿外科
    3. 510630 广州,中山大学第三附属医院泌尿外科
  • 收稿日期:2023-03-14 出版日期:2024-06-01
  • 通信作者: 林天歆
  • 基金资助:
    国家自然科学基金联合基金项目(U21A20383); 广东省援疆农村科技(特派员)项目(KTP2020321)

Development of isolated porcine kidney training model for laparoscopic partial nephrectomy

Zixu Zhang1, Junjiong Zheng2, Yun Luo3, Tianxin Lin2,()   

  1. 1. Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou 510120, China; Department of Urology, Anhui Provincial General Hospital of the Chinese People's Armed Police Force, Hefei 230041, China
    2. Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou 510120, China
    3. Department of Urology, the third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2023-03-14 Published:2024-06-01
  • Corresponding author: Tianxin Lin
引用本文:

张子旭, 郑俊炯, 罗云, 林天歆. 腹腔镜肾部分切除术离体猪肾培训模型的构建[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 277-283.

Zixu Zhang, Junjiong Zheng, Yun Luo, Tianxin Lin. Development of isolated porcine kidney training model for laparoscopic partial nephrectomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 277-283.

目的

构建琼脂糖离体猪肾肾癌模型,并验证其在泌尿外科医师腹腔镜肾部分切除术模拟培训中的应用效果。

方法

21名不同腹腔镜手术经验的泌尿外科医师参与培训,根据不同腹腔镜手术经验分为三组:无经验组(A组,n=8)、少经验组(B组,n=7)、经验丰富组(C组,n=6)。利用琼脂糖混合物注射到离体猪肾包膜下构建肾癌模型,将模型放置到腹腔镜培训模拟器中,三组学员分别进行6次培训,记录每名学员的手术时间,质量评分及全球腹腔镜技术手术评估(GOALS)评分,对每次模拟操作进行评价,比较各组学员的手术技能,评估该模型的有效性。

结果

首次培训时A、B、C三组中位手术时间、中位质量评分及中位GOALS评分两两比较均存在显著差异(P<0.05)。A组和B组的手术时间分别在第4、5次培训时达到了C组基线水平,质量评分均在第2次达到C组基线水平,GOALS评分分别在第5、4次培训时达到C组基线水平(P>0.05)。经过6次培训,三组学员的评价指标均有不同程度地改善。

结论

本研究构建了一种琼脂糖离体猪肾腹腔镜肾部分切除术培训模型,该模型经济易得,适用于不同手术经验的医师培训,可较快提高临床医师手术技能,易于推广。

Objective

To construct an agarose ex vivo porcine kidney renal carcinoma model and validate its training effectiveness in laparoscopic partial nephrectomy simulation training.

Methods

Twenty-one urologists with different laparoscopic surgical experience participated in the training and were categorized into three groups based on their laparoscopic surgical experience: no experience group (group A, n=8), little experience group (group B, n=7), and experienced group (group C, n=6). A renal cancer model using an agarose mixture injected under the envelope of isolated porcine kidneys was constructed. The model was placed into a laparoscopic training simulator and all the trainees performed 6 training sessions. Each trainee's operative time, quality scores, and GOALS scores for each simulated operation were recorded, and the evaluation metrics were compared between the three groups to assess the effectiveness of the model.

Results

During the first training, there were significant differences in the median operative time, median quality score, and median GOALS score between groups A, B, and C (P<0.05). The operative time of Group A and Group B reached the baseline level of Group C at the 4th and 5th training sessions, and the quality score reached the baseline level of Group C at the 2nd training session. The GOALS score reached the baseline level of Group C at the 5th and 4th training sessions, respectively (P>0.05). After 6 training sessions, the evaluation indicators of the three groups have improved to varying degrees.

Conclusion

This study constructed an agarose isolated porcine kidney training model for laparoscopic partial nephrectomy, which is economical and suitable for the training of surgeons with different surgical experiences. The model can improve surgical skills of surgeons and is easy to popularize and promote.

图1 离体猪肾琼脂糖肾癌模型及腹腔镜肾部分切除术模拟训练注:a为离体猪肾琼脂糖肾癌模型;b为培训医师利用模型进行腹腔镜肾部分切除术训练;c为切除癌肿后缝合肾实质;d为癌肿切除及完成缝合后
表1 培训医师腹腔镜下切除模型中癌肿质量评分表
表2 全球腹腔镜技术手术评估(GOALS)评分标准
表3 21名泌尿外科培训学员基本信息[MQ)]
表4 首次培训三组学员在手术时间、质量评分及全球腹腔镜技术手术评估(GOALS)评分的差异情况[MQ)]
图2 腹腔镜手术培训过程中三组学员各项评价指标的变化情况
表5 A、B组各次腹腔镜手术模型训练与C组训练前技能水平的比较[MQ)]
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