| ObjectiveThe aim of the study is to construct a training model with maximum simulation of the in vivo situation in LPN based on perfused isolated-porcine-kidney.Clinical doctors were recruited as volunteers to test the training model validity.And then analyze the learning curve of LPN to validate the model.Finally,this study can provide reference value for clinical doctors training.Methods1.Construction of the ex-vivo simulated bleeding modelThe isolated porcine kidney was carefully removed the appendant perirenal fat and then artery intubatton,and prepare a infusion support with 136 cm height and a beaker with 1 L volume.Two concentric circles with different diameters of 28 mm and 32mm were placed on the surface of the porcine kidney respectively.Fix the kidney model in plastic human body model.2.Effectiveness evaluation of the modelThe study recruited 20 volunteers,divided into three groups:12 volunteers as the junior group(postgraduates who had assisted at or observed laparoscopic procedures),6 volunteers as the intermediates(attending doctors who had performed laparoscopic procedures such as laparoscopic partial nephrectomy,but who rarely performed LPN procedures),6 volunteers as the experts(surgeons who had extensive LPN experience).Written informed consent was obtained from experts volunteers.Every volunteer take two surgery of partial kidney resection.The operative time,the damage of two concentric circles,the suture time,and the number and lengths of the wounds after suture,the width of wound after suture and the control rate of bleeding were recorded.The lengths of wounds were including the total length and the maximum ones.If there is a statistical difference in these three training groups,then the construction of the model is valid,and the following surgical training is practical significance.12 trainees who were selected from the junior group,were divided into two sub-groups(experimental group vs control group),and asked to perform shallow suture and partial kidney resection.Time of suture,suture placement accuracy were measured.A modified 23-point checklist was used for quality evaluation of each superficial stitches performance.Results1.In Likert scale,quality assessment of the model for anatomical structure was 5.00±0.00,bleeding simulation was 4.33±0.52,for texture was 4.33±0.52,for appearance was 4.33±0.52,and for overall realistic simulation was 4.67±0.52.LPN experts certified the model is suit for training.2.There were significant differences among the three groups in operative time,the damage of two concentric circles,the suture time,and the number and lengths of the wounds after suture,the width of wound after suture and the control rate of bleeding(P<0.05).It is showed that this model is valid and efficiency.3.The study curve analysis showed:After the 3rd training,number of inner cycle damage,suture time was reached the plateau.After the 6th training,number of outside cycle damage,the length and the longest of surgical wounds were all reached the plateau.After the 7th training,number of surgical wounds,"8" fixed suture,23-point checklist,fixed-point suture and bleeding control rate were all reached the plateau.After the eighth training,partial renal resection time and the wound gap after suture were reached the plateau.By trained with the training model for 8 times,young doctors could get stable operation skills.The experimental group is better than that of control group.ConclusionThis study constructs a LPN model successfully and the training model was suitable for advanced training of LPN after Likert scale questionnaire.The statistical analysis of the 3 training groups showed that this model is valid and efficiency.By trained with this model for 8 times,young doctors could get stable operation skills. |
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