2023 Fiscal Year Final Research Report

Development of education and assessment tool for anastomotic technique in technically demanding surgery using 3D simulation system

Research Project

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Project/Area Number	21K12745
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 90140:Medical technology assessment-related
Research Institution	Hokkaido University
Principal Investigator	Matsui Aya 北海道大学, 大学病院, 特任助教 (20894950)
Co-Investigator(Kenkyū-buntansha)	倉島庸北海道大学, 医学研究院, 准教授 (40374350) 野路武寛北海道大学, 大学病院, 助教 (10739296) 七戸俊明北海道大学, 医学研究院, 准教授 (70374353) 平野聡北海道大学, 医学研究院, 教授 (50322813)
Project Period (FY)	2021-04-01 – 2024-03-31
Keywords	膵頭十二指腸切除 / 胆管空腸吻合 / 膵空腸吻合 / 外科教育 / 胆汁漏 / 膵液漏 / 吻合部狭窄 / 縫合不全
Outline of Final Research Achievements	During the research period, it had been unable for us to take place CSTs (cadaver surgical training) due to our university’s BCP established under the COVID-19 pandemic, including the process of recruiting surgical trainees who belongs to external hospitals. Since the aim of the research was to develop effective educational tools that enable surgical trainees to achieve skills for anastomoses with high level of difficulty in HPB surgery, we, as one of the leading hospitals of HPB surgery in Japan, retrospectively analyzed 400 cases of pancreatoduodenectomy performed in our department as an alternative. As a result, we identified risk factors for early and late postoperative complications after choledochojejunostomy and pancreatojejunostomy that are known as anastomoses with high level of difficulty in HPB surgery. We believe our studies has contributed to indicate the concept of ideal anastomosis that surgical trainee should aim for.
Free Research Field	医学
Academic Significance and Societal Importance of the Research Achievements	これまで胆膵領域の高難度吻合における望ましい吻合を数値化した報告は少ない中、胆管空腸吻合における教室の10名のエキスパートのピッチは中央値で全員1mm台であることを示せた。また、胆管空腸吻合では肝門部胆管と空腸を吻合する場合、膵空腸吻合では術前主膵管径が細い場合が縫合不全と有意に関連していることが明らかとなり、より技術的難度が高い吻合で合併症の発症が多いことが示唆された。本研究が当初目的としていた評価システムの構築や教育プログラムの開発が実現できれば、十分なoff-the-jobトレーニングや適格な執刀医の選択が可能となり、合併症発症が抑制できる可能性が改めて示された。