2006, Number 2
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Rev Hosp M Gea Glz 2006; 7 (2)
Design of a biosimulator for training of advanced laparoscopic procedures
Ramírez SME, Flores GF, De la Concha y BF, Corona MH
Language: Spanish
References: 27
Page: 68-75
PDF size: 232.72 Kb.
ABSTRACT
Background: The biosimulators, fiber glass dummy in which animal organs are introduced ex-vivo, have been used in laparoscopy for one decade making exclusively basic procedure, leaving the complex or advanced ones to the experienced surgeons.
Objective: To determinate the feasibility to do advanced laparoscopic procedures in a biosimulator.
Design: Descriptive, experimental, prospective and transversal.
Methods: 4 Pathologies were designed (gastric submucous injuries, pancreatic pseudocyst, diaphragmatic hernia and choledocholithiasis) with bovine and pig organs. The submucous gastric injuries were done by transgastric laparoscopy, as well as the pancreatic pseudocyst drainage. The choledocholithiasis was solved by laparoscopic way with a transurgical choledochoscopy. The diaphragmatic hernia reduction was made by laparoscopic way. Each subject was instructed in the technique to make, each procedure was videotaped, analyzing the committed errors and the possibility of being finished satisfactorily.
Results: From March to May of 2006, 6 surgeons with previous laparoscopic training in finish each one of the laparoscopic advanced procedures with attendance of the coordinators of the Laboratory of Innovation and Investigation in Medical Education (LIIEM) of Dr. Manuel Gea González Hospital. The 100% reported to be totally in agreement with the similarity of each model of injuries and those presented in the human. The mucosectomy and the diaphragmatic repair of hernia had a success rate of 83.3%, whereas the transgastric drainage of pancreatic pseudocyst and the biliary revision were completed without incidents in the 100% of the cases. The main problem was the gas flight through the gastrotomies, for which a circular suture around trocar was placed.
Conclusion: The simulation of complex laparoscopic and endoscopic procedures allows to extend the skills acquired during these training courses beyond the offered ones by virtual simulators and without the ethical implications of the training in patients.
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