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A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training

OBJECTIVE: The goals of this laboratory model were to evaluate the performance of the surgical team and endolaparoscopic techniques in the porcine model of infrarenal abdominal aortic repair. METHODS: Twenty-four pigs underwent full endolaparoscopic aorto-aortic graft implantation with voice-activat...

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Autores principales: Martinez, Bernardo D., Zarins, Christopher K., Daunt, David A., Coleman, Leslie A., Saenz, Yamil, Fogarty, Thomas J., Hermann, George D., Nezhat, Camran R., Olsen, Eric K.
Formato: Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 2003
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015489/
https://www.ncbi.nlm.nih.gov/pubmed/12856843
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author Martinez, Bernardo D.
Zarins, Christopher K.
Daunt, David A.
Coleman, Leslie A.
Saenz, Yamil
Fogarty, Thomas J.
Hermann, George D.
Nezhat, Camran R.
Olsen, Eric K.
author_facet Martinez, Bernardo D.
Zarins, Christopher K.
Daunt, David A.
Coleman, Leslie A.
Saenz, Yamil
Fogarty, Thomas J.
Hermann, George D.
Nezhat, Camran R.
Olsen, Eric K.
author_sort Martinez, Bernardo D.
collection PubMed
description OBJECTIVE: The goals of this laboratory model were to evaluate the performance of the surgical team and endolaparoscopic techniques in the porcine model of infrarenal abdominal aortic repair. METHODS: Twenty-four pigs underwent full endolaparoscopic aorto-aortic graft implantation with voice-activated computerized robotics. The first group of 10 pigs (acute) was sacrificed while under anesthesia at 0.5 hours (5 animals) and 2 hours (5 animals). The second group of 14 pigs (survival) were recovered from anesthesia and maintained for 7 hours (5 pigs) and 7 days (9 pigs) prior to sacrifice. Survival animals were observed for evidence of hind limb dysfunction. All grafts were visually inspected at autopsy. RESULTS: All animals survived the operation. All grafts were successfully implanted, and all were patent with intact anastomoses at autopsy. Mean aortic clamp time for each group was as follows: acute, 92.9±28.04 minutes; survival, 59.6±13.8 minutes; P=0.0008. Total operative time for each group was as follows: acute, 179±39.6 minutes; survival, 164.6±48 minutes; P=0.44 ns. Estimated blood loss for each group was as follows: acute, 214±437.8 mL; survival 169.2±271 mL; P=0.76 ns. The following outcomes were observed: 1 animal died from respiratory arrest; 1 animal suffered motor sensory dysfunction of the hind limbs (spinal cord ischemia); significant bleeding occurred in 6 of 24 pigs; 8 of the 9 seven-day survivors required minimal pain medication and had normal hind limb function. CONCLUSIONS: The reduction in aortic clamp time, total operative time, and blood loss as the study progressed indicate the feasibility of this surgical protocol and the maturation of the learning process, which is paramount in prevention of 2 main sources of morbidity: bleeding and spinal cord ischemia. The reduction in aortic clamp time between the acute and survival groups was dramatic and statistically significant. An intensive formal training program combining dry and live surgical laboratories is deemed essential for the development of endoscopic skill sets necessary for this challenging procedure.
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spelling pubmed-30154892011-02-17 A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training Martinez, Bernardo D. Zarins, Christopher K. Daunt, David A. Coleman, Leslie A. Saenz, Yamil Fogarty, Thomas J. Hermann, George D. Nezhat, Camran R. Olsen, Eric K. JSLS Scientific Papers OBJECTIVE: The goals of this laboratory model were to evaluate the performance of the surgical team and endolaparoscopic techniques in the porcine model of infrarenal abdominal aortic repair. METHODS: Twenty-four pigs underwent full endolaparoscopic aorto-aortic graft implantation with voice-activated computerized robotics. The first group of 10 pigs (acute) was sacrificed while under anesthesia at 0.5 hours (5 animals) and 2 hours (5 animals). The second group of 14 pigs (survival) were recovered from anesthesia and maintained for 7 hours (5 pigs) and 7 days (9 pigs) prior to sacrifice. Survival animals were observed for evidence of hind limb dysfunction. All grafts were visually inspected at autopsy. RESULTS: All animals survived the operation. All grafts were successfully implanted, and all were patent with intact anastomoses at autopsy. Mean aortic clamp time for each group was as follows: acute, 92.9±28.04 minutes; survival, 59.6±13.8 minutes; P=0.0008. Total operative time for each group was as follows: acute, 179±39.6 minutes; survival, 164.6±48 minutes; P=0.44 ns. Estimated blood loss for each group was as follows: acute, 214±437.8 mL; survival 169.2±271 mL; P=0.76 ns. The following outcomes were observed: 1 animal died from respiratory arrest; 1 animal suffered motor sensory dysfunction of the hind limbs (spinal cord ischemia); significant bleeding occurred in 6 of 24 pigs; 8 of the 9 seven-day survivors required minimal pain medication and had normal hind limb function. CONCLUSIONS: The reduction in aortic clamp time, total operative time, and blood loss as the study progressed indicate the feasibility of this surgical protocol and the maturation of the learning process, which is paramount in prevention of 2 main sources of morbidity: bleeding and spinal cord ischemia. The reduction in aortic clamp time between the acute and survival groups was dramatic and statistically significant. An intensive formal training program combining dry and live surgical laboratories is deemed essential for the development of endoscopic skill sets necessary for this challenging procedure. Society of Laparoendoscopic Surgeons 2003 /pmc/articles/PMC3015489/ /pubmed/12856843 Text en © 2003 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Scientific Papers
Martinez, Bernardo D.
Zarins, Christopher K.
Daunt, David A.
Coleman, Leslie A.
Saenz, Yamil
Fogarty, Thomas J.
Hermann, George D.
Nezhat, Camran R.
Olsen, Eric K.
A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training
title A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training
title_full A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training
title_fullStr A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training
title_full_unstemmed A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training
title_short A Porcine Model for Endolaparoscopic Abdominal Aortic Repair and Endoscopic Training
title_sort porcine model for endolaparoscopic abdominal aortic repair and endoscopic training
topic Scientific Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015489/
https://www.ncbi.nlm.nih.gov/pubmed/12856843
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