关键词:

常温机械灌注 , 多器官联合灌注 , 腹腔镜教学

Abstract:

Objective Based on the concept of organ medicine and the application of normothermic machine perfusion technology，a new in vitro and in vivo multi-organ laparoscopic system was created. Methods Smagister consists of a normothermic machine perfusion platform，porcine abdominal organs（liver，gallbladder，pancreas， stomach，intestine，kidney，uterus，bladder，etc.），a laparoscopic light source，a laparoscopic lens，an ultrasonic scalpel，laparoscopic surgical instruments，a high-definition monitor，and a software system. The logbook recordedthe results of blood gas analysis per hour and the number of intestinal peristalsis per hour. Organ population viability was subjectively assessed hourly by means of questionnaires. Three types of Laparoscopic surgery are performed on the Smagister，including laparoscopic cholecystectomy（LC），laparoscopic enterotomy closure（LEC）， laparoscopic liver resection（LLR），to demonstrate the specific procedures of each procedure. Experts in related fields were invited to compare the feasibility of completing the operation and the demonstration of complications with the actual operation. Results The mean arterial pressure of the perfusion machine was maintained at60 mmHg（1 mmHg ＝ 0.133 kPa），blood flow at approximately 1 000 ml/min，and organ temperature between 36.5 ～ 37.4℃ throughout the procedure. The intestinal peristalsis could be clearly seen during the whole perfusion process，with an average peristalsis frequency of 2.2 times /min，which was maintained until the end of the experiment. During the laparoscopic operation，clear bile secretion could be seen when the porta hepatis were separated and the bile duct was ligated. In addition，when the blood vessel was injured during liver resection，the blood vessel rupture and blood outflow can be seen. Experts evaluated that the organ activity was good during the whole laparoscopic operation，the anatomical structure of the organ could be clearly displayed，and the tactile feedback of the operation was very real. Conclusion Smagister combines a live animal model with an ex vivo simulation，pooling the advantages of both modalities and expanding the training field to provide high-quality laparoscopic training for both novice and veteran surgeons. 

Key words:

Normothermic machine perfusion , Combined multi-organ perfusion , Training of laparoscopy