Simulation Model for Laparoscopic Foregut Surgery: The University of North Carolina Foregut Model

A significant gap presently exists between box-lap and virtual-reality simulators and live surgery. Live animal and cadaver use has significant downsides. We have developed a high fidelity, real tissue simulator that allows training in laparoscopic foregut operations.

Our foregut surgery model is based on porcine tissue blocks that include lungs, heart, aorta, esophagus, diaphragm, stomach, duodenum, liver, and spleen. The tissue block is mounted in a human mannequin and perfused with artificial blood. The anterior abdominal wall is constructed so as to allow for laparoscopic or robotic surgical training. We sought to test the model with procedures performed by expert surgeons. After completing the procedures, face validity was measured by surgeon responses to a questionnaire defining the perceived relationship to real surgery.

Five expert foregut surgeons performed laparoscopic Heller myotomy, Nissen fundoplication, and sleeve gastrectomy on the model. The simulator was rated as highly realistic in terms of tissue feel, instrument usage, and conduct of the operation for all three procedures. In addition, all surgeons felt the model could significantly shorten the learning curve for performing these procedures.

The results of this study show that our simulation model, based on animal tissue blocks, offers a very realistic representation of laparoscopic foregut operations, thus achieving a high level of face validity. The model should be very useful for training surgeons in laparoscopic foregut procedures.