A Synthetic Torso for Training and Evaluation of Laparoscopic Skills
We report the development a new synthetic torso for urologic laparoscopy training allowing the placement of animal organs in situs. The trainer, Lapman, has the exact shape of a human torso, presenting abdominal and thoracic cavities. Animal and/or synthetic models of the abdominal organs can be realistically placed in the abdominal cavity for the training operation. A disposable abdominal wall seals the cavity and can be replaced after repeated punctures with laparoscopic instruments. The thoracic cavity connects to a pump to simulate respiration. In order to render realistic properties a synthetic skeleton is incorporated within the torso, which is cast of materials with elastic properties similar to those of soft tissue. The trainer was used and evaluated by medical students, residents, and attending urologists who compared it to the standard training box. Twenty-five subjects were randomly assigned to perform predefined tasks on either Lapman or the box. The study showed that Lapman gives a more realistic approximation of the real procedure and is well suited for laparoscopy training. The use of animal organs allows for operating on real tissues, their placement in situs requires appropriate instrument access and port placement, and the induced respiration causes the organs to move as in the real case. Description (Set) Proposed Use (Set) Laparoscopic urologic surgery reduces invasiveness, resulting in decreased hospitalization and patient morbidity, lower analgesic dosages for pain control, better aesthetic results and faster recovery. Due to its complexity, however, laparoscopic surgical complications correlate highly to the level of surgeon experience.The difficulty of laparoscopy in general, the high complexity of urologic applications, and the relatively infrequent incidence of urologic cases make it essential for the urologist to have access to specialized training programs. To meet this demand, numerous urologic laparoscopy programs and short courses have been established.Training programs use a sequence of theoretical, simulator, and animal training followed by mentored surgery, whereas short courses address only the first three of these steps. Laparoscopy simulators can be classified as either physical devices of various construction or virtual reality (VR) simulators. The trainee undergoes numerous steps, beginning with the insertion of the Veress needle, insufflating the CO2, determining the port sites and placing the trocars. The trainee can then perform a variety of laparoscopic procedures that necessitate dissecting and developing tissue planes, excising and reconstructing tissue, suturing, electrocautering, and performing other surgical maneuvers in an anatomically consistent setting. The simulator gives the possibility of placing an animal kidney in the retroperitomeum for the trainee to operate on realistic tissues, thus simulating various surgeries such as renal biopsy, pyeloplasty, nephrectomy, and even partial nephrectomy.
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