Advanced paediatric laparoscopic surgery: repetitive training in a rabbit model provides superior skills for live operations.
OBJECTIVE
The rapid development of advanced laparoscopic techniques is a strong challenge for the skills and competence of the paediatric surgeon. It is therefore mandatory that training must offer adequate preparation. The present experimental study investigates how surgical residents perform laparoscopic bowel biopsy and defect repair after training with a pelvitrainer versus a rabbit model.


METHODS
New Zealand white rabbits, 3 mm instruments, a 5 mm scope and a 6 - 0 prolene suture were used. Twelve surgical residents were randomised into two groups. Their basic task was to take a seromuscular bowel biopsy laparoscopically and to repair the defect using an intracorporeal suture. Group I trained 8 times (on 8 occasions) with a pelvitrainer (PT), group II trained similarly using a rabbit model (RM). Each participant took a final test to demonstrate the operation in the rabbit. Operating time, suture time and perforation of the bowel were analysed.


RESULTS
In the PT group, mean operating times decreased from 11.18 (+/- 5.04) min to 4.91 (+/- 0.89) min (p < 0.01), however the final test procedure in the rabbit model lasted 9.62 (+/- 5.11) min. In the RM group mean operating times also decreased from 10.04 (+/- 3.39) min to 6.38 (+/- 1.40) min (p < 0.01) during the eight training operations. Within this group the final live operation lasted 5.45 (+/- 0.67) min and was significantly faster than in the PT group 9.62 (+/- 5.11) min (p < 0.1). The suture times showed a similar pattern. A significant difference with respect to the rate of perforation was not found.


CONCLUSIONS
Repetitive training in the rabbit provides superior skills for live operations. In paediatric surgical centres with advanced laparoscopic procedures, an animal model should be considered as an important step in training which may contribute to a beneficial outcome in patients.
Kinderchirurgische Klinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, 80337 München, Germany. hans-joachim.kirlum@med.uni-muenchen.de
H-J
HJ
Kirlum
M
M
Heinrich
N
N
Tillo
H
H
Till
D000818:Animals; D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D023421:Models, Animal; D010372:Pediatrics / Q000193:education; D011817:Rabbits; D013536:Suture Techniques / Q000193:education*