Porcine Models for Pediatric Minimally Invasive Surgical Training—A Template for the Future

Bidarkar, Sandeep S.; Deshpande, Aniruddh V.; Kaur, Mandeep; Cohen, Richard. D.

doi:10.1089/lap.2011.0057

Cited by 13 publications

(5 citation statements)

References 9 publications

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“…Numerous training models outside of the operating room exist that have been shown to provide excellent training opportunities. 35,36 Two-and three-dimensional training models ranging from simple shoebox-setups 37 to animal models 36,38 have been proposed and evaluated to increase exposure to MIS and help surgeons acquire the necessary skills outside of the operating room. 39 Studies have demonstrated that MIS skills -especially the training of intracorporal suturing and knottying in simulator settings-successfully transfer to the operating room, 36,40 suggesting that some of the early phase of the learning curve can be achieved outside of the OR and consequently minimize the effect of the learning curve on the patient's outcome.…”

Section: Trainees 31 Consultants 12mentioning

confidence: 99%

Minimally Invasive Pediatric Surgery: The Learning Curve

et al. 2020

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The use of minimally invasive surgery (MIS) in pediatric patients has increased over the past decades. The process of mastering a new procedure is termed the learning curve, during which the ability to operate increases but poorer outcomes are produced. We aim to analyze the current evidence on learning curves in pediatric MIS and evaluate its impact on patient's clinical outcomes. A systematic literature search was performed for studies listed on PubMed that reported on the learning curve for MIS surgical procedures. Studies were included if they stated the number of procedures required to reach a consistency in outcomes or if they compared outcomes between early and late period of MIS experience regarding the endpoints operative time, conversions, and intra-/postoperative complications. A total of 22 articles reporting on 11 surgical procedures were included in the study. Most authors reported a significant decrease in operative time as well as peri- and postoperative complications with increasing experience of the surgeon. Complications ranged from minor to major, the latter being especially severe for patients receiving pyloromyotomy (5–7% higher risk of mucosal perforation), esophageal atresia repair (15% higher leakage rate and 19–77% higher stenosis rate), or Kasai portoenterostomy (26–35% more liver transplants in the first year after surgery) during the learning curve period. Pediatric MIS comes with a considerable learning curve that may have a significant impact on the patient's clinical outcomes. Efforts should be made to minimize the effect of the learning curve on the patients.

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Section: Trainees 31 Consultants 12mentioning

confidence: 99%

Minimally Invasive Pediatric Surgery: The Learning Curve

et al. 2020

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“…The literature reports its extensive use to develop surgical experiences both in conventional and minimally invasive surgery given the similarities between the model and the human anatomy. 10 Still, the dimensions of the porcine model do not adequately comply with the anatomic characteristics of newborns and young children. 11 On the other hand, rabbit is a useful animal model for ability formation and surgical training of pediatric residents.…”

Section: Introductionmentioning

confidence: 99%

Development and Preliminary Validation of a Rabbit Model of Duodenal Atresia for Training in Pediatric Surgical Skills

et al. 2019

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Duodenal atresia is a congenital defect that requires advanced surgical skills. The objective of this study is to present an anatomical defect of duodenal atresia using a rabbit model and evaluate the preliminary experience for the training of surgical skills with pediatric surgeons. Adult white New Zealand male rabbits weighing 3.0 to 4.5 kg were used to create the defect. To simulate the bottom of the dilated blind pouch, the gastric antrum of the rabbit was obliterated using a 2-0 Prolene suture, and the cecal appendix was dissected to simulate the continuation of the duodenum. Participants performed laparoscopic duodenal atresia repair in this animal model using the iPhone trainer. Thirteen pediatric surgeons with experience in laparoscopic duodenal atresia repair assessed this model with a questionnaire on 5-point Likert-type scale. Overall, the simulated model of duodenal atresia obtained a general average score of 4.39. The highest observed average was for its physical realism, whereas the lowest score was in surgical experience. The global opinion of the model obtained a score of 4.40. In addition, all surgeons answered that this rabbit model showed the same complexity as newborns and young children in the repair of this type of defect. The inclusion of new models through rabbits in pediatric surgery programs will allow the development of advanced skills of pediatric residents and surgeons.

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“…Animal models of TEF are described [52], although work is ongoing to replace the need for bovine or other animal components with synthetic materials to improve availability, avoid the intrinsic ethical difficulties, and potentially reduce cost [51]. It remains to be seen if MIS will supplant traditional open surgery for TEF given concerns of intraoperative carbon dioxide retention and potential for higher anastamotic complications.…”

Section: Simulators In Pediatric Surgerymentioning

confidence: 99%