Training Models in Pediatric Minimally Invasive Surgery: Rabbit Model Versus Porcine Model: A Comparative Study

Autori: C. Esposito, M. Escolino, I. Draghici, M. Cerulo, A. Farina, T. De Pascale, S. Cozzolino, and A. Settimi.

Data di Pubblicazione: 30-11-2015

Rivista: JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES

Abstract:

The porcine model is the most widely used animal model for laparoscopic training. However, in pediatric surgery, an experimental setting with smaller animals could improve the training conditions. We compared the efficiency of a rabbit model versus the porcine model for training in pediatric minimally invasive surgery (MIS). Materials and Methods: At the training center of Cardarelli Hospital in Naples, Italy, 10 young pediatric surgeons underwent training sessions on rabbit and porcine models under the supervision of five experienced tutors. The results of four laparoscopic techniques (inguinal hernia repair, varicocelectomy [basic procedures], nephrectomy, and fundoplication [advanced procedures]) were evaluated in regard to mean operative time, intraoperative complications, and surgical performances. Results were analyzed using Fisher’s exact test and Student’s t test. Results: Practitioners were significantly more confident in the rabbit model compared with the pig model, es-pecially for advanced procedures (P=.03). The overall surgical performance score (ranging from 0 [unac-ceptable] to 10 [excellent]) was significantly higher in the rabbit model compared with the pig model (8.1 versus 6.0; P=.01). The most significant scoring differences between the surgical performances of the trainees in the two models were reported in regard to dissection, suturing and knot-tying, tissue handling, and handling of instruments. In addition, the length of surgery for advanced procedures was statistically shorter in the rabbit model compared with the pig model (P=.01). We found that only the performances of those who started on the pig had a significantly higher improvement when transitioning to the rabbit compared with those who started on the rabbit (P=.01). Of the trainees, 90% preferred the rabbit model to the pig model. Conclusions: On the basis of our preliminary results, rabbits are preferred over pigs as the training model in pediatric MIS. In the rabbit model it is possible to perform more procedures and perform them more easily compared with the porcine model. The rabbit model provides a comfortable approach to technical training in basic and advanced laparoscopic procedures.