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. 2022 Feb 16:20:eAO6318.
doi: 10.31744/einstein_journal/2022AO6318. eCollection 2022.

Minimally invasive swine spine surgery training: technical aspects, benefits, and anatomical limitations

Alberto Ofenhejm Gotfryd  1 , Fábio Chaud de Paula  1 , Marcel Lobato Sauma  1 , Alexandre Sadao Iutaka  1 , Luciano Miller Reis Rodrigues  1 , Guilherme Pereira Correa Meyer  1 , Marcelo Passos Teivelis  1 , Arthur Werner Poetscher  1 , David Del Curto  2 , Davi Wen Wei Kang  1 , Luciana Cintra  1 , Guilherme Buzon Gregores  1 , Mario Lenza  1 , Mario Ferretti  1
Affiliations

Minimally invasive swine spine surgery training: technical aspects, benefits, and anatomical limitations

Alberto Ofenhejm Gotfryd et al. Einstein (Sao Paulo). .

Abstract

Objective: To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans.

Methods: A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings.

Results: Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans.

Conclusion: A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1. (A and B) Positioning of the animal for posterior access route with support under the lower limb to reduce abdominal pressure
Figure 2
Figure 2. (A) Needle positioning for initial access of transforaminal endoscopy; (B) Radioscopic image of the initial dilator for transforaminal endoscopic access
Figure 3
Figure 3. (A) Table rotation for over-the-top access; (B) Radioscopic image of over-the-top decompression. The Penfield is positioned through the median line, in the pedicular region of the contralateral side
Figure 4
Figure 4. Closing of osteotomy of the spinous process by transosseous sutures
Figure 5
Figure 5. (A) Intraoperative view of dilators positioning for percutaneous pedicular screws; (B) Radioscopy image of percutaneous pedicular screws
See this image and copyright information in PMC

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