ENDOSCOPIC INTERLAMINAR DISCECTOMY. USE OF SWINE CADAVERS AS A TRAINING MODEL

ABSTRACT Objective: To analyze the possibility of using cadavers of pigs for training in endoscopic interlaminar discectomy. Methods: Five young pigs were used. The necessary instruments and equipment were used, and the endoscopic transforaminal and interlaminar percutaneous approach was performed at the L7-S1 level. A specialist surgeon performed the procedure. The points of entry, needle angulation, and subjective technical difficulties indicated by the surgeon were analyzed. Results: The mean weight of pigs was 42.2 kg. The posterolateral (transforaminal) entry point was, on average, 6.28 cm from the midline at an angulation of 32.8°. The posterior (interlaminar) entry point was on average 1.82 cm. Full-endoscopic interlaminar discectomy was possible in all animals of the sample. The structures described in the literature were visible endoscopically in 100% of the models. Conclusions: The demonstrated benefits and increased indications of endoscopic lumbar surgery created the need to establish safer and more efficient training processes. The authors raise the possibility of using experimental models to develop technical skills in endoscopy via interlaminar approach. The use of teaching tools such as animal models constitutes a new learning technique and give more confidence to surgeons. The use of cadavers of pigs, obtained according to ethics, avoids the use of human cadavers, and minimizes the development of the learning curve on patients.

摘要
研究目的：分析使用猪尸体标本开展内镜下椎板间椎间盘切除术（endoscopic interlaminar discectomy）培训的可行性。
研究方法：选取5头幼年猪作为实验对象，配备必要的器械与设备，在腰7-骶1（L7-S1）节段实施经皮内镜下经椎间孔及椎板间入路手术，由专科外科医师完成操作。分析手术穿刺点、进针角度及术者主观报告的技术操作难点。
研究结果：受试猪平均体重为42.2kg。后外侧（经椎间孔）入路穿刺点距正中线平均距离为6.28cm，平均进针角度为32.8°；后正中（椎板间）入路穿刺点距正中线平均距离为1.82cm。所有受试动物均成功完成全内镜下椎板间椎间盘切除术，内镜下可100%清晰显示文献中描述的解剖结构。
研究结论：内镜下腰椎手术的临床获益与适应证不断拓展，亟需建立更安全高效的培训流程。本研究证实可通过实验动物模型开展经椎板间入路内镜手术的技术训练，此类动物教学模型属于新型学习手段，可有效提升外科医师的操作自信心。经伦理规范获取的猪尸体标本可替代人体尸体标本，有效缩短针对患者的手术学习曲线。