Journal List > Korean J Urol > v.49(10) > 1005196

Park, Soh, Rha, Yang, and Han: The Impact of Using a Porcine Model in Laparoscopic Partial Nephrectomy Training

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.

Figures and Tables

Fig. 1
In vivo laparoscopic appearance of the tumor model (arrow).
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Fig. 2
Clamped renal pedicle by a Satinsky clamp.
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Fig. 3
Tumor resection model.
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Fig. 4
Suturing a renal defect.
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Fig. 5
The learning curves of two surgeons for each steps; total operation time (A), bowel mobilization time (B), renal pedicle dissection time (C), warm ischemic time (D), mass resection time (E) and suture time (F).
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Table 1
Comparison of training results between surgeons A and B
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*: statistical analysis by Mann-Whitney U test, : statistical analysis by Fisher's exact test

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