Validity of a Soft and Flexible 3D-Printed Nissen Fundoplication Model in Surgical Training

Yangyi Zhang^1†, Jianfu Xia^2,3†, Jiye Zhang⁴, Jinlei Mao⁵, Hao Chen⁶, Hui Lin⁷, Pan Jiang⁸, Xinzhong He⁹, Xiaodong Xu¹⁰, Mingzhu Yin^1*, Zhifei Wang^11*

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¹ Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410000, China

² Department of General Surgery, The Second Affiliated Hospital of Shanghai University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China

³ Soochow University, Soochow, Jiangsu, 215000, China

⁴ Department of General Surgery, Yueqing Hospital Affiliated to Wenzhou Medical University (Yueqing People’s Hospital), Yueqing, Zhejiang, 325600, China

⁵ The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310000, China

⁶ The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310000, China

⁷ Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China

⁸ State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou 730000, China

⁹ Department of Hepatobiliary and Pancreatic Surgery, The First People’s Hospital of Tongxiang, Tongxiang, Zhejiang, 314500, China

¹⁰ College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014

¹¹ Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310000, China

IJB 2022, 8(2), 546 https://doi.org/10.18063/ijb.v8i2.546

Submitted: 28 November 2022 | Accepted: 14 February 2022 | Published: 23 March 2022

© 2022 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

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Abstract

Rapid development of three-dimensional (3D) printing technique has enabled the production of many new materials for medical applications but the dry laboratory surgical training model made of soft and flexible materials is still insufficient. We established a new 3D-printed Nissen fundoplication training model of which materials simulate the real mechanical properties. In this study, 16 participants were divided into two groups: Experimental group and control group. The validity of model was tested using Likert scale by the experts and the experimental group. To evaluate the efficacy, performances of the experimental group were scored at the first, fourth, and eighth training by OSATS system and the duration of procedure was compared through the use of recorded video. Meanwhile, an ex vivo model was used to compare the performance of the experiment group and control group after the training in the same way. Our results showed that the 3D-printed model can support the future surgical applications, help improve surgical skills, and shorten procedure time after training.

Keywords

3D-printed model

Nissen fundoplication

Surgical training

Soft materials

References

1. Liaw CY, Guvendiren M, 2017, Current and Emerging Applications of 3D Printing in Medicine. Biofabrication, 9:024102. https://doi.org/10.1088/1758-5090/aa7279

2. Pugliese L, Marconi S, Negrello E, et al., 2018, The Clinical Use of 3D Printing in Surgery. Updates Surg, 70:381–88. https://doi.org/10.1007/s13304-018-0586-5

3. Ganguli A, Pagan-Diaz G J, Grant L, et al., 2018, 3D Printing for Preoperative Planning and Surgical Training: A Review. Biomed Microdevices, 20:65. https://doi.org/10.1007/s10544-018-0301-9

4. Yap YL, Sing SL, Yeong WY, 2020, A Review of 3D Printing Processes and Materials for Soft Robotics. Rapid Prototyp J, 26:1345–61. https://doi.org/10.1108/Rpj-11-2019-0302

5. Wallin TJ, Pikul J, Shepherd RF, 2018, 3D Printing of Soft Robotic Systems. Nat Rev Mater, 3:84–100. https://doi.org/10.1038/s41578-018-0002-2

6. Stratton S, Manoukian OS, Patel R, et al., 2018, Polymeric 3D Printed Structures for Soft-Tissue Engineering. J Appl Polym Sci, 135:45569. https://doi.org/10.1002/app.45569

7. Jin Z, Li Y, Yu K, et al., 2021, 3D Printing of Physical Organ Models: Recent Developments and Challenges. Adv Sci (Weinh), 8:e2101394. https://doi.org/10.1002/advs.202101394

8. Li X, Liu B, Pei B, et al., 2020, Inkjet Bioprinting of Biomaterials. Chem Rev, 120:10793–833. https://doi.org/10.1021/acs.chemrev.0c00008

9. Jiang T, Munguia-Lopez JG, Flores-Torres S, et al., 2019, Extrusion Bioprinting of Soft Materials: An Emerging Technique for Biological Model Fabrication. Appl Phys Rev, 6:011310. https://doi.org/10.1063/1.5059393

10. Ng WL, Lee JM, Zhou MM, et al., 2020, Vat Polymerization based Bioprinting-Process, Materials, Applications and Regulatory Challenges. Biofabrication, 12(2):022001. https://doi.org/10.1088/1758-5090/ab6034

11. Li WL, Mille LS, Robledo JA, et al., 2020, Recent Advances in Formulating and Processing Biomaterial Inks for Vat Polymerization-Based 3D Printing. Adv Healthc Mater, 9(15):2000156. https://doi.org/10.1002/adhm.202000156

12. Pietrabissa A, Marconi S, Negrello E, et al., 2020, An Overview on 3D Printing for Abdominal Surgery. Surg Endosc Other Intervent Tech, 34(1): 1-13. https://doi.org/10.1007/s00464-019-07155-5

13. Kwon J, Choi J, Lee S, et al., 2020, Modelling and Manufacturing of 3D-printed, Patient-specific, and anthropomorphic gastric phantoms: A pilot study. Sci Rep, 10:18976. https://doi.org/10.1038/s41598-020-74110-z

14. Ratinam R, Quayle M, Crock J, et al., 2019, Challenges in Creating Dissectible Anatomical 3D Prints for Surgical Teaching. J Anat, 234:419–37. https://doi.org/10.1111/joa.12934

15. Yadlapati R, Hungness ES, Pandolfino JE, 2018, Complications of Antireflux Surgery. Am J Gastroenterol, 113:1137–47. https://doi.org/10.1038/s41395-018-0115-7

16. Wu JM, Chen D, 2020, The Evolution and Expectation of Surgical Options for Gastroesophageal Reflux Disease. Zhonghua Wai Ke Za Zhi, 58:677–82. https://doi.org/10.3760/cma.j.cn112139-20200229-00162

17. Xiao YL, Zhou LY, Hou XH, et al., 2021, Chinese Expert Consensus on Gastroesophageal Reflux Disease in 2020. J Dig Dis, 22:376–89. https://doi.org/10.1111/1751-2980.13028

18. La Torre M, Caruso C, 2013, The Animal Model in Advanced Laparoscopy Resident Training. Surg Laparosc Endosc Percutan Tech, 23:271–5. https://doi.org/10.1097/SLE.0b013e31828b895b

19. Daly SC, Wilson NA, Rinewalt DE, et al., 2014, A Subjective Assessment of Medical Student Perceptions on Animal Models in Medical Education. J Surg Educ, 71:61–4. https://doi.org/v10.1016/j.jsurg.2013.06.017

20. Tanaka H, Yoshino H, Kobayashi E, et al., 2004, Molecular Investigation of Hepatitis E Virus Infection in Domestic and Miniature Pigs Used for Medical Experiments. Xenotransplantation, 11:503–10. https://doi.org/10.1111/j.1399-3089.2004.00170.x

21. Copaescu C, Dragomirescu C, 2009, The Pig Model for the Laparoscopic Antireflux Surgery Training. Chirurgia (Bucur), 104:309–15.

22. He J, Fang Y, Chen X, 2015, Surgical Models of Gastroesophageal Reflux with Mice. J Vis Exp, 102:e53012. https://doi.org/10.3791/53012

23. Filho EV, Goldenberg A, Costa HO, 2005, Experimental Model of Gastroesophageal Reflux in Rats. Acta Cir Bras, 20:437–44. https://doi.org/10.1590/s0102-86502005000600008

24. Wei F, Xu M, Lai X, et al., 2019, Three-dimensional Printed dry Lab Training Models to Simulate Robotic-assisted Pancreaticojejunostomy. ANZ J Surg, 89:1631–5. https://doi.org/10.1111/ans.15544

25. Horgan S, Pohl D, Bogetti D, et al., 1999, Failed Antireflux Surgery what have we Learned from Reoperations? Arch Surg, 134:809–15. https://doi.org/10.1001/archsurg.134.8.809

26. Lundell L, 2004, Complications after Anti-reflux Surgery. Best Pract Res Clin Gastroenterol, 18:935–45. https://doi.org/10.1016/j.bpg.2004.08.004

27. Maret-Ouda J, Wahlin K, El-Serag HB, et al., 2017, Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux. JAMA, 318:939–46. https://doi.org/10.1001/jama.2017.10981

28. Lin HH, Lonic D, Lo LJ, 2018, 3D Printing in Orthognathic Surgery a literature review. J Formos Med Assoc, 117:547–58. https://doi.org/10.1016/j.jfma.2018.01.008

29. Weidert S, Andress S, Suero E, et al., 2019, 3D Printing in Orthopedic and Trauma Surgery Education and Training: Possibilities and Fields of Application. Unfallchirurg, 122:444–51. https://doi.org/10.1007/s00113-019-0650-8

30. Hatala R, Cook DA, Brydges R, et al., 2015, Constructing a Validity Argument for the Objective Structured Assessment of Technical Skills (OSATS): A Systematic Review of Validity Evidence. Adv Health Sci Educ Theory Pract, 20:1149–75. https://doi.org/10.1007/s10459-015-9593-1

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