Training model for the fetal myelomeningocele correction with multiportal endoscopic technique.

Autor: da Costa MDS; Department of Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, São Paulo, SP, 04024-002, Brazil. marcoscostaneuro@gmail.com.; Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil. marcoscostaneuro@gmail.com., Nicacio JM; Department of Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, São Paulo, SP, 04024-002, Brazil.; Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil., Dastoli PA; Department of Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, São Paulo, SP, 04024-002, Brazil.; Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil., Suriano IC; Department of Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, São Paulo, SP, 04024-002, Brazil.; Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil., Sarmento SGP; Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, SP, Brazil.; Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil., Barbosa MM; Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, SP, Brazil.; Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil., Moron AF; Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, SP, Brazil.; Department of Fetal Medicine, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil., Cavalheiro S; Department of Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, São Paulo, SP, 04024-002, Brazil.; Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2023 Nov; Vol. 39 (11), pp. 3131-3136. Date of Electronic Publication: 2023 Feb 25.
DOI: 10.1007/s00381-023-05893-5
Abstrakt: Purpose: The recent history of myelomeningocele has shown that treatment during the fetal life may reduce the risk of developing hydrocephalus in individuals by approximately 50%. Thus, a significant advancement involves fetal surgery performed through an endoscopic technique in which portals are placed to introduce the forceps and laparoscopic instruments. However, the development of this technique requires training; therefore, this study aimed to develop a training model for fetal myelomeningocele repair technique with multi-portal endoscopy.
Methods: Two stages of endoscopic technique development were performed. The first stage consisted of exercises in order to familiarize the surgeon with 2D-vision endoscopic surgery, associated with the application of exercises focused on surgical skills, such as the development of laparoscopic knots in a synthetic model. The second stage involved the creation and application of the stages of myelomeningocele closure with a non-living animal model consisting of a chicken breast to simulate the myelomeningocele and a basketball to simulate the gravid uterus, in which perforations were made to introduce vascular introducers (portals) that, as in vivo, are used as portals (trocars) for the introduction of laparoscopic instruments. Overall, two different scenarios with three portals and two portals were tested.
Results: In three-portal simulator, the triangular apex trocar was used for the introduction of 4-mm 0° or 30° optics or even Minop type neurodoscope (Aesculap®, Germany) that was operated by the assistant surgeon; the other two portals are used for the introduction of laparoscopic instruments. Thus, the surgeon is able to perform maneuvers bimanually since dissection to laparoscopic sutures. In two-portal simulator, the surgeon and assistant stay side by side and one of the portals is used for the optic and the other for the laparoscopic instruments. There is no possibility of bimanual dissection in this method.
Conclusion: Realistic simulation models for endoscopic fetal surgery for myelomeningocele correction are easily performed and help develop the necessary skills for fetal surgery teams.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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