"Simulation of a Laparoscopic Major Vessel Injury in a Live Animal Model"

Abstract

Objective: Iatrogenic injury to major vessels is a rare but potentially life-threatening complication during laparoscopic hepato-pancreato-biliary surgery. This experimental study aimed to assess the usefulness of an in-vivo animal model for the management of such injuries.Methods: During three editions of advanced live animal laparoscopy courses 12 participants were exposed to 19 intraoperative iatrogenic vessel injuries. The participants were free to control the bleeding using maneuvers of their choice. The participants' heart rate was measured, and their movements were video recorded. The study was evaluated by all participants using a Visual Analogue Scale at the end of the course.Results: Temporary vessel control was obtained in all cases. One animal died due to relapse of bleeding. Heart rate (HR) of participants ranged from 52 to 97 per minute before the task and from 75 to 120 per minute during the task. Eleven participants gave this exercise a 5/5 score and one gave it a score of 3/5. The HR was higher in experienced surgeons vs. inexperienced residents although this difference did not reach statistical significance. Conclusion:In-vivo pig and sheep model can be used for training in major bleeding control during HPB surgery. It is highly appreciated by trainees. It seems that stress level during advanced exercises is higher in experienced surgeons than in beginners.