Laparoscopic ultrasonography - A training model

The purpose of this study was to develop a surgical training program and to test the accuracy of laparoscopic ultrasound in detecting injected lesions in pig livers. METHODS: Pig livers were divided into eight segments and in jected with Surgilube(R) "malignant" and silicone "benign" lesions. All wer e examined by laparoscopic ultrasound followed by liver explantation to con firm results. First, a pilot study was conducted on six swine by injecting Surgilube(R) lesions and performing laparoscopic ultrasound through 3 diffe rent ports (left upper quadrant (I), umbilicus (II), and right lower quadra nt (III)) to determine per-segment accuracy and to optimize port placement. Second. blinded injection of Surgilube; and silicone implants was done on 18 pigs with laproscopic ultrasound conducted through the two most accurate ports from the pilot study. This model was then tested during a. resident training workshop. RESULTS: In the pilot study; per-lesion and per-segment sensitivity was 96 percent, with no difference among the three ports used. Ports I and II mere chosen for the blinded study for their convenience in p erforming laparoscopic colectomy. In the blinded study, per-segment sensiti vity, specificity, and accuracy were 97 percent, 94 percent, and 96 percent and 99 percent, 94 percent, and 97 percent for ports I and II, respectivel y. At the conclusion of a pilot workshop, trainee per-segment sensitivity, specificity, and accuracy were 60 percent, 80 percent, and 70 percent, resp ectively. The major difficulty was differentiating benign from malignant le sions. CONCLUSIONS: A useful liver laparoscopic ultrasound training model f or surgeons aas developed with good preliminary results. It is anticipated chat further training will enhance laparoscopic ultrasound accuracy rates b efore application of this modality in humans.