Category: Education, Simulation & Virtual Reality
Introduction & Objective : Fluorescenceguidance has gained popularity during urologic surgery in recent years. The aim was to establish an ex-vivo pig kidney model for training fluorescence guided surgery in laparoscopic partial nephrectomy (LPN).
Methods : Six pig kidneys were used for establishing the model. Both two kidneys were extracted with the long aorta from fresh slaughtered pig. The kidneys were freshly frozen after they were rinsed with a cooled heparinized solution. After transportation of the kidneys in cooled box, the kidneys were warmed in approx. 12 hours at room temperature. The renal arteries were dissected and cannulated by vessel cannulas that enabled connection to a perfusion pump. P.O.P. trainers (Optimist Gmbh, Austria) were used for perfusion of the kidneys. Laparoscopic segmental renal arteries dissections were performed while the kidney was re-perfused with perfusate solution. After placing the bulldog clamps on the segmental renal arteries, indocyanine green (ICG) solution was started to circulate with a dilution of 1/200. Then, one of the bulldog clamps was taken out and avascular kidney segment was seen under fluorescence camera system (Karl-Storz, Germany). LPN was carried out in all six kidneys with a standard fashion.
All six kidneys could be re-perfused with perfusate solution. ICG could be seen in all six kidneys under fluorescence camera system that reflected the appropriate tissue perfusion. Avascular renal segments were successfully created in the kidneys. The total cost of preparation of this kidney model per kidney was 160 Euros.
Conclusions : This model is the first ex-vivo training model aiming to demonstrate fluorescence guidance in urological surgeries. It is feasible and effective training tool for LPN. When comparing the hands-on training courses with using anesthetized pigs, this model is cheap and can be easily established in any dry laboratory conditions. We think it may help to increase awareness and knowledge of fluorescence guided surgery in urology.