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

摘要：

目的 基于器官医学理念的提出以及常温机械灌注技术的运用，创建一种新的体外活体多器官腹腔镜系统。 方法 Smagister 由常温机械灌注平台、猪腹腔多脏器（肝、胆囊、胰腺、胃、肠、肾、子宫、膀胱等）、腹腔镜光源、腹腔镜镜头、超声刀、腹腔镜手术器械、高清显示器和软件系统组成。记录每小时血气分析结果和肠道每小时蠕动次数。每小时采用问卷调查的方式对器官群活力进行主观评估。在 Smagister 上进行 3 种腹腔镜手术，包括胆囊切除术（laparoscopic cholecystectomy，LC）、肠切开缝合术（laparoscopic enterotomy closure，LEC）和肝切除术（laparoscopic liver resection，LLR），并演示每种手术的具体操作。邀请相关领域专家从完成手术的可行性和并发症的演示等方面与实际手术进行了比较。结果 在整个手术过程中，灌注机器的平均动脉压维持在 60 mmHg（1 mmHg ＝ 0.133 kPa），血流约为1 000 ml/min，器官温度维持在 36.5 ～ 37.4 ℃。整个灌注过程中可以清晰的看到肠道蠕动，平均蠕动次数为 2.2 次 /min，并一直维持到实验结束。在进行腹腔镜手术操作过程中当分离肝门结扎胆道时可以看到清晰的胆汁分泌。并且在肝脏切除手术过程中损伤到血管时可以看到血管破裂血液流出，专家评估整个腹腔镜操作过程中器官活性良好，器官的解剖结构能够清晰的展现，手术的触觉反馈十分真实。结论 Smagister 将活体动物模型和离体模拟相结合，集中了两种模式的优点，扩展了训练领域，为新手医生和资深外科医生提供了高质量的腹腔镜训练。

关键词:

常温机械灌注 , 多器官联合灌注 , 腹腔镜教学