Development and validation of a composed canine simulator for advanced veterinary laparoscopic training

Training total laparoscopic gastropexy using a composed simulator and evaluating the significant transfer of surgical skills performed in growing pigs in vivo

BACKGROUND

An advanced curriculum for training Total Laparoscopic Gastropexy (TLG) was developed using the CVLTS-composed simulator based on an ergonomic model of a canine abdominal cavity. The performance of Veterinary surgeons trained in basic laparoscopic surgical skills during 15 training TLG sessions (experimental group, n = 10) was compared to the TLG performance of veterinary surgeons with intermediate (n = 10) or advanced (n = 6) laparoscopic skills. The transfer of surgical skills to a live model was assessed by performing TLG in fattening pigs under operating room conditions using barbed sutures. Experimental group performance after accomplishing the TLG training curriculum and all groups' performance during TLG in the in vivo model were videotaped and evaluated by external Minimally Invasive Surgery (MIS) experts using the GOALS and TLG-specific ranking (SRS) scales. Also, a quantitative assessment comprising time, smoothness of movements, and angular displacement using a Hand Movement Assessment System (HMAS) was performed. Besides, a postmortem biopsy recovered from the gastropexy site three months after surgery to evaluate gross and microscopic characteristics by histopathology was analyzed.

RESULTS

GOALS and SRS scores (P < 0.05), and time, smoothness of movements, and angular displacement during TLG (P < 0.01) significantly improved in the Experimental group after training. They also compared their performance with expert and intermediate groups (P < 0.05) performances. The learning curve for intracorporeal suture stabilized since the tenth (out of 15) training session. Besides, trainees achieved significant TLG skills' in vivo transfer, with no significant difference from the intermediate and expert group performances. The presence of mature collagen (100% of cases), cartilage and bone metaplasia, and foreign body reaction (25% of cases) were found at histopathology evaluation of the gastropexy site, evidencing normal healing.

CONCLUSION

The TLG training curriculum supported the acquisition of TLG surgical skills in the training box and their transfer to the in vivo model. The experimental group's TLG performance in vivo did not significantly differ from the intermediate and expert groups. The clinical outcome and histopathological findings evidenced complete gastropexy-site healing.

Description and biomechanical evaluation of the modified laparoscopic-assisted percutaneous gastropexy technique in dogs

Background

Total laparoscopic gastropexy (TLG) has become increasingly popular due to its minimally invasive nature, requiring only three ports and no additional skin incisions aside from those for port placement. However, a notable limitation of TLG is the difficulty and time required for intracorporeal suturing. To address this challenge, we investigated a new technique-modified laparoscopic-assisted percutaneous gastropexy (mLAPG)-in canine cadavers.

Materials & methods

Twelve canine cadavers were divided into mLAPG (n = 6) and TLG (n = 6) groups. mLAPG was performed using a knotless barbed suture with two ports, and TLG was performed using a single-layer continuous barbed suture. Both methods employed a suture length of 3 cm and four suture bites. The total surgical time (TST) and gastropexy suturing time (GST) were recorded. Upon completion of the procedure, the stomach and body wall, including pexy site, were collected to evaluate the maximum load to failure of the gastropexies.

Results

No significant differences were observed in the TST between the mLAPG (61.83 ± 4.80 min) and TLG (65.33 ± 12.05 min) groups (p = 0.538). The GST showed no significant difference between the mLAPG group (31.33 ± 3.13 min) and the TLG group (37.5 ± 7.06 min) (p = 0.095). The mLAPG group (35.86 ± 8.24 N) had a significantly higher maximum load to failure than the TLG group (24.04 ± 7.16 N) (p = 0.024).

Conclusion

The results of this study suggest that the mLAPG, with its minimal invasiveness, absence of an intracorporeal suturing process, and high tensile strength can be clinically applied for gastropexy in dogs. However, further clinical trials are warranted to further validate this technique and confirm its effectiveness.

Approaches to Laparoscopic Training in Veterinary Medicine: A Review of Personalized Simulators

Veterinary minimally invasive surgery (MIS) has experienced notable growth in recent years, yet the availability of specialized training tools remains limited and not readily accessible to practitioners worldwide. While borrowing simulators from human medicine practices suffices for acquiring fundamental laparoscopic skills, it proves inadequate when addressing procedure-specific nuances. Veterinary professionals are now taking steps to create simulators tailored to their patients, although the validation process can be time-consuming. Consequently, the availability of advanced laparoscopic simulators for veterinary training remains scarce. The present study aims to highlight custom-made simulators. A comprehensive search across five databases was conducted to uncover the simulators documented from 2010 to 2022. A total of five simulators emerged from this search, with four grounded in a canine model and only one in an equine model. These models underwent validation and were found to be effective in training surgeons for their designated tasks. The findings underscore a limited array of simulators, predominantly catering to two species (horses and dogs). Considering these findings, it is evident that further research is imperative to create laparoscopic simulators capable of facilitating advanced veterinary training. This would enable the continued evolution of surgical techniques across diverse species, including ruminants, small mammals, and non-mammalian animals.

Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs

This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey's contrast test. No statistically significant differences were found between the novice group's performance after training and the expert group's performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.