市販の物理シミュレーターを用いた犬の腹腔鏡下胆嚢摘出術の教育：2次元および3次元可視化

To evaluate the feasibility of a commercial simulator to reproduce key steps of canine laparoscopic cholecystectomy, and to compare surgical performance when using 3-D versus 2-D visualization.

16 gallbladder inserts mounted in a laparoscopic cholecystectomy model were used. Inserts were randomly assigned to 2-D or 3-D visualization groups and placed in a laparoscopic training box. All procedures were performed on a single day in 2022 by 1 American College of Veterinary Surgeons resident who completed prestudy training on the simulator to minimize learning-curve effects. A board-certified surgeon supervised all procedures. Surgical steps included cystic duct dissection, endoclip application, cystic duct transection, and gallbladder removal. Measured outcomes included surgical times for defined intervals, total procedure time, intraoperative complications, and residual simulated liver tissue attached to the gallbladder.

Time from instrument insertion to first endoclip placement and total surgical time were significantly shorter with 3-D visualization compared to 2-D, and the differences in medians suggested clinically meaningful improvements in performance. There were no significant group differences in bile leakage, incomplete clipping, or the amount of residual foam attachment.

This physical simulator allowed reproduction of most key procedural steps in canine laparoscopic cholecystectomy. Three-dimensional visualization improved surgical efficiency for a trainee operator.

The simulator provided a safe, accessible platform for early skills acquisition before progressing to cadaveric or clinical training.