Background Gastrointestinal perforation is commonly seen in emergency departments. The perforation of the stomach is an emergency situation that requires immediate surgical treatment. The necessary surgical skills require regular practical training. Owing to patient`s safety, in vivo training opportunities in medicine are restricted. Animal tissue especially porcine tissue, is commonly used for surgical training. Due to its limiting factors, artificial training models are often to be preferred. Many artificial models are on the market but to our knowledge, none that mimic the haptic- and sewing properties of a stomach wall at the same time. In this study, an open source silicone model of a gastric perforation for training of gastric sewing was developed that attempts to provide realistic haptic- and sewing behaviour. Methods To simulate the layered structure of the human stomach, different silicone materials were used to produce three different model layups. The production process was kept as simple as possible to make it easily reproducible. A needle penetration setup as well as a systematic haptic evaluation were developed to compare these silicone models to a real porcine stomach in order to identify the most realistic model. Results A silicone model consisting of three layers was identified as being the most promising and was tested by clinical surgeons. Conclusions The presented model simulates the sewing characteristics of a human stomach wall, is easily reproducible at low-costs and can be used for practicing gastric suturing techniques. Trial registrations Not applicable.
Students dissection classes again and again reveal unique anatomical variations and pathologies, which are usually preserved and stored in fluid. Due to their unique nature and hazardous conservation fluids, they neither ever leave their display case again nor are handed over to students at the dissection lab. Thus the present study aims at routinely generating solid, dry, and numerically unlimited 3D‐replica of such unique specimens. We have selected a particularely severe case of Mönckebergs aortic valve sclerosis and a transcatheter aortic valve implantation (TAVI)‐treated valve to develop a standard scanning, segmentation and multicolor 3D‐printing protocol for soft and hard tissue specimens. Subsequent to anatomical dissection of the appropriate valve segment from the ventricular outlet and the ascending aorta, scanning was performed on a Skyscan 1173 micro‐CT at a x‐y‐z resolution of 30µm. Soft tissue, calcified tissue, and the TAVI's wire cage were segmented separately using the software packages Slicer and Medtool. For 3D‐printing, the Prusa MK3S filament printer and the Prusa SL 1 resin printer were used. The overall time expense for scanning (40 minutes), data processing and segmentation (about 16 hours) was around two to three working days per model. The 3D‐printing took from 5 hours (single‐color resin printing at a scale of 1:1) up to 4 days (triple‐color filament printing at a scale of 3:1). The generated display models range from real size, opaque surface models to semi‐vitreous visualizations of the calcification pattern and the implanted TAVI. Taken together, after a substantial time expenditure for initial data processing and modeling, with small time requirements not only hands on replica for teaching can be easily reproduced at different scales without limitation by specimen durability or chemical hazards. Additional impact is achieved by the ability to highlight and analyze internal structures in situ, making laborious, traditional whole mount staining and ‐clearing dispensable. In a next step, the adaption of colors and material characteristics will approximate the haptic experience to the real specimen.
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