Image-Guided Surgical Training in Percutaneous Hepatobiliary Procedures: Development of a Realistic and Meaningful Bile Duct Dilatation Porcine Model

Giménez, Mariano Eduardo; Vázquez, Alain García; Davrieux, Carlos Federico; Verde, Juan M.; Serra, Edgardo; Palermo, Mariano; Houghton, Eduardo Javier; Dallemagne, Bernard; Perretta, Silvana; Acquafresca, Pablo; Diana, Michèle; Marescaux, Jacques

doi:10.1089/lap.2020.0680

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Models using virtual EUS simulators 13 , explants 14 , and 3 D printed bile ducts with dilation for EUS-guided biliary drainage 15 and rendezvous procedures 16 have been described, but most clinicians find them unrealistic or lacking haptic validity. Several more sophisticated and realistic in vivo models created by laparoscopic CBD ligation 8 17 , laparoscopic double-balloon occlusion 9 , by thermal radiofrequency injury creating biliary strictures 11 18 19 and endoscopic clipping with band ligation 20 have been described and shown to be effective. However, these efforts have several limitations, including up to 2-week survival periods required to achieve bile duct dilation 10 and the inability to obtain realistic gallbladder dilation.…”

Section: Discussionmentioning

confidence: 99%

“…The use of animal models while expensive, is probably the best alternative to practicing on humans, as to date, useful virtual reality simulators for EUS do not exist. The creation of bile duct models in animals for training using methods such as laparoscopic common bile duct (CBD) ligation [8,9], endoscopic papilla clipping [10], endobiliary radiofrequency ablation [11], and peroral cholangioscopy [12] has been described, but they have several shortcomings. Some require invasive and morbid surgery, long survival times, proprietary and hard-to-access equipment or result in poor or inconsistent dilatation.…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a novel porcine bile duct dilation model for EUS training

et al. 2022

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Background and study aims Image-guided minimally invasive techniques have transformed the management of malignant and benign bile duct obstructions. These evolving techniques are being widely adopted and applied and hands-on training using high quality models is required to improve the proficiency of practitioners. This experimental study aimed to validate an in vivo porcine model created to simulate bile duct dilation for interventional endoscopic ultrasound (EUS) hands-on training curriculums. Materials and methods Thirty-six porcine models were involved and the procedures were performed in an experimental hybrid operating room under general anesthesia. Animals underwent endoscopic duodenal papilla clipping with several hemostatic metallic clips. After a survival period of 24 to 48 hours, the models with effective intrahepatic and extrahepatic bile duct dilatation were included in the hands-on training. Trainees and faculty were given structured evaluations of the model realism and usefulness. Results Extrahepatic bile duct and gallbladder dilation was achieved in all 36 of the models, and in 11 of the 36 models, a treatable intrahepatic duct dilatation was achieved. During the hands-on training, EUS-guided biliary drainage, EUS-guided transgastric gallbladder drainage, and EUS through-the-needle microbiopsy forceps procedures were feasible. Overall, 75 % of the experts and trainees evaluated the training as excellent. Conclusions We present a minimally invasive, reliable and time- effective model of extrahepatic dilation suitable for interventions. The model was less effective for intrahepatic ducts, which should be considered if intrahepatic biliary dilation is required for training.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development and validation of a novel porcine bile duct dilation model for EUS training

et al. 2022

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“…They are used as clinical and surgical skills training models. For instance, pigs are still commonly used in terminal experiments to practice surgical skills in human medicine (Deonarain et al, 2020;Giménez et al, 2020), and rabbits are used for training neonatal intubation procedures (Okhovat et al, 2020;Ulmer et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Educational use of animals in Europe indicates a reluctance to implement alternatives

Zemanova¹,

Knight

Lybæk³

2021

ALTEX

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Animals have been considered an indispensable tool to teach about the functioning of living organisms, to obtain skills necessary for practicing human and veterinary medicine, as well as for acquiring skills for caring for and conducting experiments on animals in laboratories. However, the efficacy of this practice has been questioned in the last decades and societal views have evolved to put a much larger emphasis on animal welfare and ethics that needs to be reflected in our teaching and training practices. Currently, many alternatives to harmful animal use are available, and it is not clear why thousands of animals continue to be used every year for educational and training purposes. Therefore, this study aimed to identify reasons for the lack of uptake of non-harmful educational and training methods by analysing recently published non-technical summaries in the EU and EEA Member States, and to provide examples of alternatives for specific learning objectives. Results from non-technical summaries from 18 countries spanning the most recent years (2017-2019) revealed that the two main perceived reasons for continued animal use are 1) the necessity of using a living animal for 'proper' learning and 2) the lack of an adequate alternative. We argue that these reasons often do not reflect reality. In conclusion, we consider it is necessary to put a stronger emphasis on engagement with ethical questions that underlie the use of animals and careful consideration of how the learning objectives could be achieved through non-harmful alternatives.

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Cholangioscopy under direct visualization: skill progress during a dedicated Image-Guided Surgery Course

Gimenez,

Uribe Rivera,

Montanelli

et al. 2023

Surg Endosc

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Image-Guided Surgical Training in Percutaneous Hepatobiliary Procedures: Development of a Realistic and Meaningful Bile Duct Dilatation Porcine Model

Cited by 4 publications

References 15 publications

Development and validation of a novel porcine bile duct dilation model for EUS training

Development and validation of a novel porcine bile duct dilation model for EUS training

Educational use of animals in Europe indicates a reluctance to implement alternatives

Cholangioscopy under direct visualization: skill progress during a dedicated Image-Guided Surgery Course

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