应用离体猪肾构建腹腔镜下肾部分切除术的培训模型

目的 应用猪肾构建简便的培训模型,使受训者能够在模拟肾脏具有持续血供的环境下行腹腔镜下肾部分切除术(LPN),掌握手术过程中的技术要点.方法 将新鲜的保留肾门的离体猪肾放置在打开的金属盒上,用红色的液体行肾动脉灌注以模拟肾脏的血供.特殊设计的金属盒放置猪肾的同时还能储存经肾动脉人工灌注后流出的灌注液.受训者被要求在猪肾上切除直径约2 cm的球形肾脏组织,并缝合肾盂、肾实质.参与培训的受训者对腹腔镜手术的操作能力基本相当,且均已完成腹腔镜“干实验室”培训计划.在20 d的培训期内,记录受训者完成LPN所用的时间,并由培训指导员全程监督手术过程和手术质量.结果 培训结束后,平均手术总时间由(46.1±1.6) min降低至(27.9±1.8) min(P＜0.001),第4次培训后手术总时间开始有明显的缩短;肾脏部分切除后肾盂、肾实质缝合时间从(30.4±1.8) min下降至(19.4±1.2)min(P＜0.001).受试者手术质量评分从开始的(2.02±0.19)分上升至结束时的(4.41±0.14)分(P＜0.001),其中前5次培训的质量评分上升趋势较明显.所有受训者在10次培训结束后对完成高质量的LPN充满信心.结论 应用易于获得的离体猪肾构建简便、经济的培训模型,通过培训,可使受训者获得完成LPN所需的手术技巧.

A new training model for laparoscopic partial nephrectomy using isolated porcine kidney

Objective To create a simple model for teaching laparoscopic partial nephrectomy(LPN) in a simulated continuous blood supply setting and to introduce the main technical points of the procedure. Methods A fresh porcine kidney was placed on an unfolded metallic box,and the renal artery was infused with red-dyed water to simulate the blood supply of the kidney. The specially designed metallic box could not only fix and position the kidney, but also store the outflow of the kidney while the artery was kept artificially infused. The trainees were required to excise about 2 cm spherical renal parenchyma tissue and to suture the pelvis and renal parenchyma. The trainees had a similar laparoscopic competency and they all completed the dry laboratory training programs. During a 20-day training period, the trainees were assessed by the time periods they needed to complete LPN. The procedure and the quality of the LPN were monitored by the training mentors.Results The mean operating time decreased from (46.1±1.64) min (range, 43-49 min) before training to (27.9±1.79) min (range, 25-31 min) after training (P<0.001). The operating time required for suture-repairing the pelvis and renal parenchyma began to decrease after performing the fourth procedure, with the time decreased from (30.4±1.82) min to (19.4±1.16) min (P<0.001). The mean quality score increased from 2.02±0.19 at the beginning to 4.41±0.14 at the end of the training (P<0.001). The increase of the quality score was faster during the first five procedures. All the trainees became confident in performing a high quality LPN after completing ten procedures. ConclusionThe present model with isolated porcine kidney is simple and economic. It can offer the trainees the opportunities to learn all the skills necessary for LPN.