돼지를 이용한 복강경하 부분신절제술 훈련의 효과

Abstract

PURPOSE: We assessed the impact of using a porcine model on the training of laparoscopic partial nephrectomy(LPN) and compared the training effectiveness between surgeons with and without previous laparoscopic experience. MATERIALS AND METHODS: Surgeon A had previous laparoscopic experience, with the exception of LPN, while surgeon B had no prior laparoscopic experience. A tumor model was created by subcapsular injection of liquid plastic(Smooth-Cast 320) in the kidney. We recorded the total operation time, the bowel dissection time, the renal pedicle dissection time, the warm ischemic time, the mass resection time, the suture time, and the presence of major complications for each surgeon. RESULTS: The mean operation time was significantly shorter for surgeon A compared to surgeon B(49.1+/-4.5 and 63.6+/-8.4 minutes, respectively, p<0.001). Although the mass resection time was significantly shorter for surgeon A as well, there were no significant differences between the two surgeons in terms of warm ischemia time and suture time. As the training progressed, surgeon B improved in all surgical steps and surgeon A showed improvement in time for warm ischemia and suturing the defect. Five complications occurred(two cases by surgeon A and three cases by surgeon B). CONCLUSIONS: A porcine model improved the skills needed for LPN, including shortening the warm ischemia and suture times. LPN is a procedure requiring technically-demanding skills that can be improved by training using a animal model, regardless of the previous laparoscopic experiences.