Residents Can Do It! A Training Program in Laparoscopic Liver Surgery for General Surgery Residents

Abstract

Introduction: Laparoscopic liver resections (LLRs) constitute an area of surgery that has been kept away from residents in their hands-on training. The aim of our study is to assess the feasibility and the value of a didactic “step-by-step” program for LLR performed by residents using the swine training model. Methods: From May 2018 to November 2019, three hands-on workshops were held. The protocol involved the performance of cholecystectomy, liver mobilization, minor and major hepatectomies. The participants’ performance results in terms of operative time, blood loss, conversion, trainers’ intervention, and intraoperative mortality, were recorded. The first workshop was comprised of 30 residents who previously participated in laparoscopic surgery workshops. In the second workshop, after six residents dropped out due to residency completion, the findings for the remaining 24 residents were compared to those for 24 junior-attending surgeons who did not follow the protocol and had not performed LLR previously, and to another 24 residents in a third workshop, who had not taken the training program before but followed the protocol. Results: All residents fully completed the surgical procedures. Trained residents achieved better operative times and less blood loss compared to junior-attending surgeons (p < 0.017), however, the remaining parameters were comparable. When compared to non-trained residents, those who underwent training achieved significantly better results only in operative times (p < 0.001). Conclusion: A continuous LLR “step-by-step” training program on swine for residents is feasible and the “step-by-step” protocol is a valuable tool for a proper surgical education.

© 2023 The Author(s). Published by S. Karger AG, Basel

References Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection–2,804 patients. Ann Surg. 2009;250:831–41. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015;261(4):619–29. Croome KP, Yamashita MH. Laparoscopic vs. open hepatic resection for benign and malignant tumors: an updated meta-analysis. Arch Surg. 2010;145(11):1109–18. Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, et al. Laparoscopic versus open hepatic resections for benign and malignant neoplasms- a meta-analysis. Surgery. 2007;141(2):203–11. Abu Hilal M, Di Fabio F, Teng MJ, Godfrey DA, Primrose JN, Pearce NW. Surgical management of benign and indeterminate hepatic lesions in the era of laparoscopic liver surgery. Dig Surg. 2011;28(3):232–6. Long TCD, Bac NH, Thuan ND, Dat LT, Viet DQ, Chuong LCHQ. Laparoscopic liver resection: 5-year experience at a single center. Surg Endosc. 2014;28(3):796–802. Fretland AA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, et al. Laparoscopic versus open resection for colorectal liver metastases, the OSLO-COMET randomized controlled trial. Ann Surg. 2018;267(2):199–207. Hallet J, Sa Cunha A, Cherqui D, Gayet B, Goéré D, Bachellier P, et al. Laparoscopic compared to open repeat hepatectomy for colorectal liver metastases: a multi-institutional propensity-matched analysis of short- and long-term outcomes. World J Surg. 2017;41(12):3189–98. Osman H, Parikh J, Patel S, Jeyarajah DR. Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study. HPB. 2015;17(3):265–71. Animal models for human disease and research uses. Netvet.wustl.edu. 2018. [cited 20 April 2018]. Available from: http://netvet.wustl.edu/species/pigs/pigmodel.txt. Popa C, Ober C, Vrîncianu R, Cicortas B, Cîmpean C, Al Hajjar N, et al. The surgical anatomy of the swine liver: new way of learning for residents in training. Rev Rom Med Vet. 2019;29(4):11–7. Lada E, Anna M, Patrik M, Zbynek T, Miroslav J, Hynek M, et al. Porcine liver anatomy applied to biomedicine. J Surg Res. 2020;250(250):70–9. Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, et al. In: Lobo DN, editor. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine. 2015;94(20). p. e764. Nilsson C, Sorensen JL, Konge L, Westen M, Stadeager M, Ottesen B, et al. Simulation-based camera navigation training in laparoscopy: a randomized trial. Surg Endosc. 2017;31(5):2131–9. Seymour NE, Gallagher AG, Roman SA, O'’Brien MK, Bansal VK, Andersen DK, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458–63; discussion 463–4. Olasky J, Sankaranarayanan G, Seymour NE, Magee JH, Enquobahrie A, Lin MC, et al. Identifying opportunities for virtual reality simulation in surgical education: a review of the proceedings from the innovation, design, and emerging alliances in surgery (IDEAS) conference: VR surgery. Surg Innov. 2015;22(5):514–21. Alaker M, Wynn GR, Arulampalam T. Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis. Int J Surg. 2016;29:85–94. Imakuma ES, Ussami EY, Meyer A. Laparoscopic training model using fresh human cadavers without the establishment of penumoperitoneum. J Minim Access Surg. 2016;12(2):190–3. Huri E, Ezer M, Chan E. The novel laparoscopic training 3D model in urology with surgical anatomic remarks: fresh-frozen cadaveric tissue. Turk J Urol. 2016;42(4):224–9. Leblanc F, Senagore AJ, Ellis CN, Champagne BJ, Augestad KM, Neary PC, et al. Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models. J Surg Educ. 2010;67(4):200–4. Blaschko SD, Brooks HM, Dhuy SM, Charest-Shell C, Clayman RV, McDougall EM, et al. Coordinated multiple cadaver use for minimally invasive surgical training. JSLS. 2007;11(4):403–7. Zhang H, Liu T, Wang Y, Liu HF, Zhang JT, Wu YS, et al. Laparoscopic left hepatectomy in swine: a safe and feasible technique. J Vet Sci. 2014;15(3):417–22. Komorowski AL, Mituś JW, Sanchez Hurtado MA, Sanchez Margallo FM. Porcine model in the laparoscopic liver surgery training. Pol Przegl Chir. 2015 Aug;87(8):425–8. Teh SH, Hunter JG, Sheppard BC. A suitable animal model for laparoscopic hepatic resection training. Surg Endosc. 2007;21(10):1738–44. Maruthappu M, Gilbert BJ, El-Harasis MA, Nagendran M, McCulloch P, Duclos A, et al. The influence of volume and experience on individual surgical performance: a systematic review. Ann Surg. 2015;261(4):642–7. Cruz JASd, Passerotti CC, Frati RMC, Reis STD, Okano MTR, Gouveia EM, et al. Surgical performance during laparoscopic radical nephrectomy is improved with training in a porcine model. J Endourol. 2012;26(3):278–82. La Torre M, Caruso C. Resident training in laparoscopic colorectal surgery: role of the porcine model. World J Surg. 2012 Sep;36(9):2015–20. Daly SC, Hooper EA, Rinewalt D, Myers JA, Millikan KW, Luu M. Resident training in single-incision compared with traditional cholecystectomy. JSLS. 2013 Jul–Sep;17(3):361–4. Van Wagensveld BA, Van Gulik TM, Gelderblom HC, Scheepers JJ, Bosma A, Endert E, et al. Prolonged continuous or intermittent vascular inflow occlusion during hemihepatectomy in pigs. Ann Surg. 1999 Mar;229:376–84. Haberstroh J, Ahrens M, Munzar T, Waninger J, Salm R, Matern U, et al. Effects of the Pringle maneuver on hemodynamics during laparoscopic liver resection in the pig. Eur Surg Res. 1996;28(1):8–13. Shimoda M, Iwasaki Y, Sawada T, Kubota K. Protective effect of ischemic preconditioning against liver injury after major hepatectomy using the intermittent Pringle maneuver in swine. Pathobiology. 2007;74(1):42–9. Haberstroh J, Ahrens M, Munzar T, Waninger J, Salm R, Matern U, et al. Effects of the pringle maneuver on hemodynamics during laparoscopic liver resection in the pig. Eur Surg Res. 1996;28(1):8–13. Article / Publication Details

First-Page Preview

Abstract of Research Article

Received: August 02, 2022
Accepted: December 07, 2022
Published online: January 02, 2023

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 4

ISSN: 0014-312X (Print)
eISSN: 1421-9921 (Online)

For additional information: https://www.karger.com/ESR

Figures Thumbnail Tables Thumbnail Thumbnail Thumbnail Thumbnail

留言 (0)

沒有登入
gif