Construction And Validation Of A Systematized Laparoscopic Training Curriculum For Hepatic Segment Surgery And Validation

BackgroundWith the fast development of modern hepatobiliary surgery,the medical treatment model has been changed from the traditional invasive empirical one to the modern minimally invasive customized precise zone,especially mature laparoscopic surgery facilitates the course.Now precise laparoscopic surgery for hepatic tumor in the certain hepatic segment has become routine.Minimally invasive laparoscopic hepatobiliary surgery demands a doctor to consider that good understanding and identification of hepatic duct anatomical structure and adjacent relationship among hepatic duct as well as the surgeries' operation skills for laparoscopic hepatobiliary surgery is of great importance.Therefore,in this study,an advanced systematized laparoscopic training curriculum for left hepatobiliary segments surgery combined 3D printing with perfusion technology of isolated organ was to constructed and validated.This systematized laparoscopic training curriculum would contain not only the foundational education curriculum of hepatic anatomy,but also advanced systematized laparoscopic operation skills training curriculum,which parenchyma dissection,vessels identification and ligation,and bleeding control were involved.For the foundational education curriculum of hepatic segment anatomy,two "child"courses were to designed from different perspectives and to enrich the education curriculum.ObjectiveFor the transformation of the modern minimally invasive customized precise medicine model and the wide application of laparoscopic system in laparoscopic hepatobiliary segments surgery,this study was aimed to construct an advanced systematized laparoscopic training curriculum for left hepatobiliary segments surgery combined 3D printing with perfusion technology of isolated organ and validated its effectiveness.MethodsEthics StatementEthical approval was obtained from the Human Research Ethics Committee,Southern Medical University,Guangzhou,China.The subjects gave informed consent.And all consent was written in nature regarding body donation for research.The construction and effective validation of foundational education curriculum of hepatic segment anatomy based on 3D printingIn order to explore the availability and utility value of 3D printing,two "child"courses were designed from different perspectives.In part A course,we developed a novel 3DP hepatic segment model and evaluated the teaching effectiveness of 3DV and 3DP models compared to traditional instruction with anatomical atlases.For subsequent part B course,three types of 3D printing model of hepatic segments from which an optimal model was screened as a teaching aid to improve anatomical teaching effects were constructed.Part AA healthy candidate(female,50 years old)was recruited and scanned with computed tomography(CT).After three-dimensional(3D)reconstruction,the computed 3D images of the hepatic structures were obtained.The parenchyma model was divided into 8 hepatic segments to produce the 3DV hepatic segment model.The computed 3DP model was designed by removing the surrounding parenchyma and leaving the segment sheaths.Then,6 experts evaluated the 3DV and 3DP models using a five-point Likert scale.A randomized controlled trial was conducted to evaluate the educational effectiveness of these models compared to traditional instruction with an anatomical atlas.Part BA fresh human cadaveric liver without hepatic disease was CT scanned.After 3D reconstruction,3 types of 3D computer model of hepatic structures were designed and 3D printed as:models of hepatic segments without parenchyma(type 1)and with transparent parenchyma(type 2),and hepatic ducts with segmental partitions(type 3).The models were evaluated by 6 experts using a five-point Likert scale.92 medical freshmen were randomized into four groups to learn hepatic segments with the aid of the three types of model and traditional anatomic atlas(TAA).Their results of two quizzes were compared to evaluate the teaching effects of the four methods.The construction and effective validation of advanced training curriculum of laparoscopic liver resection based on perfusion technology of isolated organ26 participants with different levels of laparoscopic experience were divided into three groups to test the construct validity of CPTMs using global score of GOALS,completion time,rate of vessel hurt,the number of vessel hurt,and the dissection number of vessels while three other indices related to suture skills including bleeding amount,suture time,and suture knot performance.Each group was required to finish the whole procedure of left lateral sectionectomy of liver,expert group also evaluate CPTM using likert scale.In order to evaluate efficiency of short-term training workshop using CPTM.Fourteen intermediates were randomized into 2 group:Training Group(n=7)and Control Group(n=7).Training Group receive training on CPTM,while Control Group only receive primary laparoscopic training.Before and after a 10-days training,the performance of left lateral sectionectomy in both groups was assessed using the rate of vessel hurt,the number of vessel hurt,average suture knot performance,average suture time,and global score of GOALS.Results1.3D printing model of hepatic segments could significantly improve anatomical teaching effects;2.laparoscopic training curriculum with perfusion technology of isolated organ could significantly improve essential skills for LLR?ConclusionIn conclusion,an advanced systematized laparoscopic training curriculum for hepatobiliary segments surgery with perfusion technology of isolated organ can offer trainees a good understanding of hepatic segment anatomical structure as well as an economic,convenient,and highly simulated-bleeding means to acquire essential skills for LLR.