Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease.

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Developing a realistic model for the training of the laparoscopic Nissen fundoplication

INTRODUCTION: A realistic human anatomy simulation model developed for training to perform laparoscopic Nissen fundoplication (antireflux surgery) could reduce the need and use of animal tissue models. This article elaborates the designing process of this model and the development process used to create the abdominal organs with realistic haptic feedback. METHOD: Before developing the artificial organs, first the mechanical characteristics of human tissue were examined. Next, separate animal organs that resembled these characteristics the closest was used to create the model. The haptic feedback of the intra-abdominal organs variables studied included tissue, geometry, and context. The stress-strain curves of the different tissues were calculated and compared with the properties of industrial materials to find the best material for the production of the organs. RESULTS: The aspects that influenced haptic feedback as determined above and used to select the most promising material groups were: E-modulus, density, coefficient of friction, sensitivity to tearing, wall thickness, and shelf life. Based on these criteria, silicone and latex materials mimiked human tissue best. Changeable velvet rope was used for connections of the organs to the surface and other simulated tissue. CONCLUSIONS: A reusable modular model of the upper abdomen anatomy with haptic properties was created for training of upper gastrointestinal surgery laparoscopic procedures, such as the Nissen fundoplication

Training for laparoscopic Nissen fundoplication with a newly designed model: a replacement for animal tissue models?

BACKGROUND: To bridge the early learning curve for laparoscopic Nissen fundoplication from the clinical setting to a safe environment, training models can be used. This study aimed to develop a reusable, low-cost model to be used for training in laparoscopic Nissen fundoplication procedure as an alternative to the use of animal tissue models. METHODS: From artificial organs and tissue, an anatomic model of the human upper abdomen was developed for training in performing laparoscopic Nissen fundoplication. The 20 participants and tutors in the European Association for Endoscopic Surgery (EAES) upper gastrointestinal surgery course completed four complementary tasks of laparoscopic Nissen fundoplication with the artificial model, then compared the realism, haptic feedback, and training properties of the model with those of animal tissue models. RESULTS: The main difference between the two training models was seen in the properties of the stomach. The wrapping of the stomach in the artificial model was rated significantly lower than that in the animal tissue model (mean, 3.6 vs. 4.2; p = 0.010). The main criticism of the stomach of the artificial model was that it was too rigid for making a proper wrap. The suturing of the stomach wall, however, was regarded as fairly realistic (mean, 3.6). The crura on the artificial model were rated better (mean, 4.3) than those on the animal tissue (mean, 4.0), although the difference was not significant. The participants regarded the model as a good to excellent (mean, 4.3) training tool. CONCLUSION: The newly developed model is regarded as a good tool for training in laparoscopic Nissen fundoplication procedure. It is cheaper, more durable, and more readily available for training and can therefore be used in every training center. The stomach of this model, however, still needs improvement because it is too rigid for making the wrap

Robot assisted versus laparoscopic suturing learning curve in a simulated setting

BACKGROUND: Compared to conventional laparoscopy, robot assisted surgery is expected to have most potential in difficult areas and demanding technical skills like minimally invasive suturing. This study was performed to identify the differences in the learning curves of laparoscopic versus robot assisted suturing. METHOD: Novice participants performed three suturing tasks on the EoSim laparoscopic augmented reality simulator or the RobotiX robot assisted virtual reality simulator. Each participant performed an intracorporeal suturing task, a tilted plane needle transfer task and an anastomosis needle transfer task. To complete the learning curve, all tasks were repeated up to twenty repetitions or until a time plateau was reached. Clinically relevant and comparable parameters regarding time, movements and safety were recorded. Intracorporeal suturing time and cumulative sum analysis was used to compare the learning curves and phases. RESULTS: Seventeen participants completed the learning curve laparoscopically and 30 robot assisted. Median first knot suturing time was 611 s (s) for laparoscopic versus 251 s for robot assisted (p  0.05). CONCLUSION: The learning curve of minimally invasive suturing shows a shorter task time curve using robotic assistance compared to the laparoscopic curve. However, laparoscopic outcomes show good end results with rapid outcome improvement

Author Response to "Congenital Diaphragmatic Hernia is Associated with Nonscrotal Testes"

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