Laparoscopic esophagogastric anastomosis training method

Abstract

The application discloses a laparoscopic esophagus and jejunum anastomosis training method and belongs to the technical field of laparoscopic operation training. The method is used for operation training of an isolated digestive tract specimen and comprises the following steps: obtaining an isolated esophagus specimen and an isolated jejunum specimen; using a guide support device to press and position a predetermined incision point in the center of the isolated esophagus stump and form an opening by full-layer incision; completing linear stapler anastomosis under the assistance of the guide support device, so that the common opening is located in the central region of the isolated esophagus stump; using the isolated esophagus stump as a positioning mark to close the common opening by full-layer continuous suture; and using the same suture to reinforce each operation suture in the muscle layer. The application solves the problems of poor controllability of a traditional anastomosis training opening, easy mucosal retraction, easy misplacement of an instrument, poor visual field exposure, no suture reference and great difficulty in standardization, can realize accurate positioning, high standardization, and standardized laparoscopic anastomosis training that can be reproduced, and significantly improves the training quality and effect of surgical laparoscopic skills.

Description

Technical Field

[0001] This invention belongs to the field of laparoscopic surgical operation training technology, specifically relating to a laparoscopic esophagojejunostomy training method. Background Technology

[0002] Laparoscopic esophagojejunostomy is a core procedure in laparoscopic digestive tract reconstruction that is highly challenging and requires strict adherence to standardized procedures. It is also a key training component in surgical laparoscopic skills training and standardized surgical instruction. High-quality anastomosis requires rigorous standardization in instrument placement and positioning, tissue incision control, mucosal alignment accuracy, closure of common openings, and reinforcement of anastomotic structures. These are important indicators for evaluating the proficiency and standardization of laparoscopic procedures.

[0003] Currently, simulation training for laparoscopic esophagojejunostomy largely follows traditional clinical surgical procedures. Mainstream training methods include the classic overlap anastomosis method and various modified overlap anastomosis techniques. Existing training programs primarily rely on ex vivo digestive tract specimens to replicate the traditional side-to-side anastomosis procedure. This involves making an incision on the side of the ex vivo esophageal stump, using an ex vivo jejunal opening to perform a linear anastomosis, and finally suturing the common opening closed. This is also the mainstream method for laparoscopic anastomosis skills training.

[0004] However, in standardized training practice, the aforementioned traditional training methods have significant shortcomings, seriously affecting training effectiveness, operational standardization, and consistency in skill replication. Specific problems are as follows:

[0005] First, traditional training methods have poor control over the location of the esophageal lateral incision. Current training methods often choose the lateral region of the excised esophageal stump as the incision site. Due to the characteristics of the specimen tissue, tissue retraction, and the endoscopic operating angle, trainees find it difficult to accurately and stably control the size and depth of the incision. This can easily lead to problems such as an incision that is too small, making it difficult to insert the anastomosis device, or an incision that is too large, affecting the quality of subsequent suturing and closure. The standardization of training operations is low.

[0006] Second, insufficient esophageal mucosal incision and edge retraction are prominent issues. In simulated training operations, the mucosa is prone to intraluminal retraction after the isolated esophageal tissue is severed. Using the conventional outside-to-inside incision method, the seromuscular layer is often completely cut, but the mucosal layer is not completely cut, resulting in insufficient exposure of the isolated esophageal lumen. This makes it impossible to complete standard instrument alignment training and seriously affects the standardization of training operations.

[0007] Third, there is the risk of misplacement of instruments. Because traditional training methods cannot guarantee that the esophageal opening mucosa is fully expanded, the anastomosis arm is prone to misplacement into the esophageal wall during training. This makes it impossible to accurately replicate the standard intracavitary insertion operation, resulting in a low training error tolerance rate and the formation of incorrect operating habits, which is not conducive to the development of standardized skills.

[0008] Fourth, the lateral common opening provides poor visual exposure, resulting in unsatisfactory training observation. In the traditional side-to-side anastomosis training mode, the common opening is located on the side of the esophageal stump, limiting the laparoscopic field of view. Trainees cannot clearly observe the alignment of the isolated esophagus and isolated jejunum mucosa, making it difficult to accurately practice the core operations of full-thickness alignment and uniform suturing, resulting in insufficient training precision.

[0009] Fifth, the lack of a unified reference standard for suturing operations makes standardized training difficult. In existing training methods, the intact structure of the esophageal stump is damaged, and there are no clear and unified suturing positioning marks. Trainees cannot accurately control the needle entry position and depth, making it difficult to ensure that each suture completely penetrates the entire thickness of the isolated esophagus or jejunum, thus failing to achieve standardized and unified suturing training.

[0010] Sixth, the overall operation process is cumbersome, and the learning threshold for beginners is high. The existing anastomosis training process has fragmented operation steps and unclear positioning logic, which requires trainees to have extremely high spatial judgment ability and laparoscopic operation proficiency. The operation is difficult to replicate, making it difficult to achieve batch and standardized teaching and training of laparoscopic anastomosis skills.

[0011] In summary, current training programs for laparoscopic esophagojejunostomy on ex vivo digestive tract specimens lack a precise, standardized, visually clear, and easily replicable laparoscopic esophagojejunostomy training protocol. There is an urgent need to design a standardized anastomosis training method adapted to ex vivo digestive tract specimens to address the technical problems of poor standardization, high replication difficulty, and poor teaching effectiveness in existing training techniques. Summary of the Invention

[0012] In view of this, the purpose of this invention is to provide a laparoscopic esophagojejunostomy training method to solve the problems of poor controllability of the opening position, easy mucosal retraction, easy misplacement of instruments, poor exposure of the surgical field, lack of unified reference benchmark for suturing, and difficulty in standardizing and replicating the operation when conducting anastomosis training based on ex vivo digestive tract specimens. This invention aims to achieve precise, standardized, and batch-replicable laparoscopic esophagojejunostomy training.

[0013] To achieve the above-mentioned objectives, the technical solution adopted is as follows:

[0014] This invention discloses a laparoscopic esophagojejunostomy training method for training the operation of isolated digestive tract specimens. The method includes the following steps: S1, obtaining an isolated digestive tract specimen, which includes an isolated esophagus and an isolated jejunum; S2, pressing a guiding support device through the lumen of the isolated esophagus to a predetermined incision point in the central region of the isolated esophageal stump, and performing a full-thickness incision of the isolated esophagus at the predetermined incision point to form an isolated esophageal opening; S3, inserting one arm of a linear anastomosis device into the isolated jejunal opening, and inserting the other arm through the isolated esophageal opening into... Inside the isolated esophagus, a linear anastomosis device is fired to form an anastomosis between the isolated esophagus and the isolated jejunum; wherein, the isolated esophagus is placed above the isolated jejunum, and the common opening at the anastomosis site is located in the central region of the isolated esophageal stump; S4, using the isolated esophageal stump as a suture positioning marker, the walls of the isolated jejunum and the isolated esophagus are continuously sutured with sutures to close the common opening; S5, the seromuscular layer is reinforced with the cutting line of the isolated esophageal stump formed in step S2, the anastomosis line formed in step S3, and the closure line of the common opening formed in step S4.

[0015] Among them, "extracorporeal esophageal stump" refers to the terminal section area formed after the esophageal tissue is cut off, which is the main operating location for this training operation; "extracorporeal esophageal lumen" refers to the hollow lumen inside the extracorporeal esophagus; "common opening" refers to the shared opening formed when the extracorporeal esophagus and extracorporeal jejunum are anastomosed.

[0016] Furthermore, in step S2, the guiding support device is a rigid nasogastric tube, which is used to press down on the isolated esophageal stump and guide the incision.

[0017] Furthermore, in step S2, the predetermined incision point is located in the central region of the posterior wall of the isolated esophageal stump and is adjacent to the staple line of the isolated esophageal stump.

[0018] Furthermore, in step S2, the predetermined cutting point is 2-3 mm away from the staple line.

[0019] Furthermore, in step S2, after the full-thickness incision is completed, the guiding support device is further advanced so that its distal end protrudes outward through the opening of the isolated esophagus, causing the edge of the isolated esophageal mucosa to evert and converge towards the center, forming a flat mucosal edge that is not easily retracted.

[0020] Furthermore, in step S3, the other arm of the linear anastomosis device is inserted into the lumen of the isolated esophagus through the opening of the isolated esophagus under the guidance of a rigid nasogastric tube.

[0021] Furthermore, in step S4, when closing the common opening, the outer edge of the isolated esophageal stump is used as a reference, and the suture needle passes through the serosa, muscle layer and mucosa of the isolated esophagus in sequence, and penetrates the entire thickness of the corresponding isolated jejunal wall.

[0022] Furthermore, in step S5, the seromuscular layer reinforcement adopts horizontal mattress suture. First, one side of the residual angle of the detached esophageal stump is buried, and the seromuscular layer is sutured along the common opening closure line. Then, the other side of the residual angle is buried, and finally the anastomosis is rotated to reinforce the anastomosis line.

[0023] Furthermore, in step S5, the same suture is a barbed suture.

[0024] The advantages of this invention compared to the prior art are as follows:

[0025] (1) The central position of the isolated esophageal stump is cut, which is not affected by tissue retraction and endoscopic perspective. The opening position and size are easier to control, effectively improving the level of standardized operation.

[0026] (2) By relying on the guiding support device to press the lumen, the mucosa can be prevented from retracting, ensuring that the tissue is cut open in its entirety, so that the lumen is fully exposed and the instrument alignment training can be carried out normally.

[0027] (3) The guide support device can guide the stapler to be smoothly inserted into the lumen, avoid accidentally entering the gap between the tube walls, reduce operational errors, and help trainees form standardized operating habits.

[0028] (4) The common opening is located in the center of the isolated esophageal stump, providing a good laparoscopic field of view, allowing clear observation of tissue alignment, facilitating full-thickness suturing practice, and improving training accuracy.

[0029] (5) Using the isolated esophageal stump as a suturing reference, the positioning is clear, the needle insertion position and layer can be standardized, and the suturing can be carried through the entire tissue layer, reducing the difficulty of standardized suturing training.

[0030] (6) The overall operation steps are well-organized and logically clear, with low entry difficulty and easy-to-replicate operation actions, making it suitable for large-scale and standardized training in laparoscopic anastomosis skills.

[0031] The following describes in detail a laparoscopic esophagojejunostomy training method of the present invention with reference to the embodiments shown in the accompanying drawings. Attached Figure Description

[0032] Figure 1 This is a flowchart illustrating the steps of the laparoscopic esophagojejunostomy training method of the present invention.

[0033] Figure 2 This is a schematic diagram showing the location of the esophageal stump incision point according to the present invention.

[0034] Figure 3 This is a schematic diagram of the esophageal stump mucosal smoothing treatment of the present invention.

[0035] Figure 4 This is a schematic diagram of the insertion of the anastomosis device of the present invention.

[0036] Figure 5 This is a schematic diagram of the central overlapping esophagojejunostomy formation of the present invention.

[0037] Figure 6 This is a schematic diagram of the full-thickness suture performed with the esophageal stump as a reference in this invention.

[0038] Figure 7 This is a schematic diagram of the common opening closure and the reinforcement of the second seromuscular layer in this invention. Detailed Implementation

[0039] To make the objectives, technical solutions, and advantages of this invention clearer, the technical solutions of this invention will be clearly and completely described below in conjunction with embodiments of this invention. Obviously, the described embodiments are one embodiment of this invention, and not all embodiments. All other embodiments obtained by those skilled in the art based on the embodiments of this invention without creative effort are within the scope of protection of this invention.

[0040] like Figure 1 As shown in the figure, this embodiment provides a laparoscopic esophagojejunostomy training method. This method is applied to the standardized operation training of isolated digestive tract specimens and is used to carry out esophagojejunostomy operation skills training. The specific implementation steps are as follows:

[0041] S1, Obtain morphologically intact isolated digestive tract specimens, including isolated esophagus and isolated jejunum.

[0042] S2, the guiding support device is inserted into the isolated esophagus lumen and pressed against the predetermined incision point in the central region of the esophageal stump. A full-thickness incision is made at this location to form the esophageal opening. In this embodiment, a rigid nasogastric tube is used as the guiding support device, which can both support the esophageal stump tissue and assist in positioning the incision location. The incision point is set in the central region of the posterior wall of the esophageal stump, adjacent to the suture line, with the distance between the two controlled at 2-3 mm. After completing the full-thickness incision, the nasogastric tube is continued to be pushed forward, so that its distal end extends out of the esophageal opening, causing the mucosal edge to evert and converge inward, forming a flat mucosal edge that is not easy to retract, laying the foundation for subsequent instrument placement and mucosal alignment.

[0043] S3. Insert one arm of the linear anastomosis device into the opening of the isolated jejunum, while the other arm, guided by a rigid nasogastric tube, is inserted into the lumen of the isolated esophagus. Once the position is confirmed, fire the anastomosis device to complete the anastomosis between the isolated esophagus and the isolated jejunum. During the procedure, the isolated esophagus is positioned above the isolated jejunum, and the common opening formed after the anastomosis is located in the central region of the esophageal stump, facilitating observation by the trainee and subsequent procedures.

[0044] S4. Using the intact esophageal stump as a suture reference, the jejunal wall and esophageal wall are continuously sutured together in full thickness to close the common opening. During suturing, the needle path is determined by referring to the outer edge of the esophageal stump. The needle passes through the esophageal serosa, muscle layer, and mucosa layer in sequence, while also passing through the full thickness of the jejunal wall at the corresponding location to ensure tight tissue apposition.

[0045] S5, using the same suture, reinforce the seromuscular layer along the esophageal stump cutting line, the esophagojejunal anastomosis line, and the common opening closure line. In this embodiment, barbed sutures are used to complete the suturing and reinforcement operations. The reinforcement method is horizontal mattress suture: first, bury one side of the esophageal stump, complete the seromuscular layer suture along the closure line, and then bury the other side of the stump; then rotate the anastomosis to fully expose the anastomosis line and complete the reinforcement, thus completing the reinforcement of each cutting line.

[0046] Before formal training begins, the specimen is pre-treated by using a laparoscopic linear cutting closure device to horizontally sever the isolated esophagus at a safe cutting edge, resulting in a clean-edged esophageal stump. For example... Figure 2 As shown, after the isolated esophagus is horizontally severed using a linear anastomosis device, a regular esophageal stump is formed. During training, the two corners of the stump can be pulled to slightly evert the edges of the stump, facilitating precise positioning of the incision location. This method preferably marks the predetermined incision point at the center of the posterior wall of the esophageal stump, approximately 2-3 mm from the staple line of the anastomosis device. In actual training, the incision point can also be flexibly adjusted according to the specimen morphology and the operating field of vision.

[0047] After the incision points are located, a rigid nasogastric tube is inserted into the esophageal lumen. The tube's pressure against the predetermined incision point causes the layers of esophageal tissue to adhere to each other. For example... Figure 3 As shown, a rigid nasogastric tube is inserted into the lumen of the isolated esophagus to press and fix the predetermined incision point. The trainee can use an electric hook to perform a full-thickness incision from the outside in, with an incision width of approximately 5 mm, slightly smaller than the outer diameter of the nasogastric tube. Alternatively, an ultrasonic scalpel can be used as the incision instrument during training. After the distal end of the nasogastric tube exits the incision, it can cause the esophageal mucosal edge to evert and converge towards the center, effectively improving the problems of mucosal retraction and incomplete tissue incision in routine operations. This results in a clear, flat mucosal edge that is not prone to retraction, ensuring a regular mucosal morphology and facilitating precise alignment of subsequent instrument placement with the mucosa.

[0048] When processing isolated jejunal specimens, a small incision is made at the mesenteric margin of the efferent loop of the jejunum, 20-25 cm from the stump, to place the anastomosis device. For example... Figure 4As shown, after the pre-made opening on the mesenteric side of the isolated jejunal outlet loop, one arm of the linear anastomosis device is smoothly inserted into the jejunal opening, while the other arm, guided precisely by a rigid nasogastric tube, extends into the isolated esophagus, completing the alignment and assembly of the anastomosis device. This method employs a superimposed anastomosis structure with the esophagus above and the jejunum below, which differs from the traditional lateral anastomosis mode. This effectively avoids the problem of instruments accidentally entering the gaps in the tube wall and helps trainees develop standardized instrument operation habits.

[0049] Once the instruments are aligned and the position is confirmed to be correct, the linear stapler can be fired. Figure 5 As shown, after the linear anastomosis device is fired, it can quickly and stably complete the anastomosis operation between the isolated esophagus and the isolated jejunum. The final common opening is located in the central area of ​​the esophageal stump, which is in the center of the training field of vision throughout the process. The field of vision is fully exposed and unobstructed, which makes it easy for the trainee to intuitively check the anastomosis morphology and mucosal alignment, and to promptly detect and correct operational deviations, thereby improving the standardization of training.

[0050] After the anastomosis is completed, the intact esophageal stump can serve as a suture positioning marker, solving the problems of lack of a unified reference and difficulty in controlling the needle insertion level in traditional training methods. Figure 6 As shown, the trainee uses the outer edge of the isolated esophageal stump as a precise positioning marker. Under direct vision, using barbed sutures or other medical sutures, they sequentially suture through the esophageal serosa, muscle layer, mucosa, and the corresponding jejunal wall layers, performing continuous full-thickness suture closure of the common opening. This ensures complete full-thickness alignment of the esophagus and jejunum, reducing operational errors such as missing mucosal sutures or only suturing the seromuscular layer. With a clear central field of vision, the trainee can judge the suture spacing and quality in real time, effectively reducing training errors. After the common opening is closed, the esophageojejunal anastomosis line, the esophageal stump cutting line, and the opening closure line are basically in the same central area, facilitating subsequent reinforcement work using a single suture.

[0051] After the full-thickness suture of the common opening is completed, there is no need to change the sutures; continue the seromuscular reinforcement operation using barbed sutures and a horizontal mattress suture technique. For example... Figure 7 As shown, after completing the full-thickness closure of the common opening, a second layer of seromuscular reinforcement suture can be performed on the anastomotic area. This involves sequentially embedding and reinforcing multiple critical lines, including the esophageal stump cutting line, the esophagojejunal anastomosis line, and the common opening closure line. During the procedure, the two residual corners of the esophageal stump are first embedded, then reinforcement is carried out systematically along each suture line. Simultaneously, the anastomosis can be rotated to fully expose the posterior anastomotic area, completing comprehensive reinforcement and ultimately forming a structurally stable anastomosis. This method allows for the simultaneous reinforcement of multiple critical lines in one operation, avoiding problems such as intersecting lines, obstructed vision, and incomplete reinforcement in traditional training. This makes the entire procedure more coherent and standardized, helping trainees fully understand the core operational logic of anastomotic reinforcement.

[0052] This training method is widely adaptable, applicable to both traditional laparoscopic operation training scenarios and robot-assisted laparoscopic operation training. Furthermore, this approach is primarily used for Roux-en-Y esophagojejunostomy-related skills training, but can also be extended to training scenarios for other types of esophagojejunostomy operations, demonstrating its flexibility and versatility.

[0053] The training method used in this embodiment has several significant advantages over traditional overlap matching training methods and their various improvements:

[0054] 1. More controllable esophageal opening positioning: Relying on the rigid nasogastric tube for positioning, trainees can accurately complete the full-thickness incision, stably control the size and direction of the incision, and greatly improve the standardization of operation.

[0055] 2. Smoother and clearer mucosal edges: The supporting and everting action of the nasogastric tube can effectively inhibit mucosal retraction and curling, making the mucosal edges more regular and providing a good foundation for trainees to practice precise mucosal apposition techniques.

[0056] 3. Reduce the risk of misplacement of instruments in gaps: Using a nasogastric tube as an intracavitary guiding structure can guide the anastomosis device to be accurately placed into the cavity, reducing errors such as misplacement of instruments and misplacement in gaps, and helping trainees develop standardized and regulated instrument operation habits.

[0057] 4. More complete exposure of the common opening and better field of vision: The overlapping anastomosis structure ensures that the common opening is always in the center of the field of vision without any obstruction, making it easy for trainees to observe the tissue status and check the standardization of operation throughout the process.

[0058] 5. More reliable full-thickness suturing training: Using the complete esophageal stump as a unified reference standard, the needle entry position and depth can be clearly determined, ensuring that the entire esophageal tissue is effectively included in the suturing range, greatly improving the accuracy of suturing training.

[0059] 6. Reduce training operation errors and improve anastomosis quality: The entire process, from mucosal apposition and full-thickness suturing to seromuscular layer reinforcement, has been optimized, effectively reducing various operational deviations and comprehensively improving the quality of esophageal-jejunal anastomosis simulation training.

[0060] 7. Reduce training problems related to anastomotic stenosis: With a clear and controllable operating field of view, the suture spacing and tissue adhesion shape can be precisely controlled, reducing the problem of simulated anastomotic stenosis caused by uneven suturing and tissue shrinkage.

[0061] 8. The operation process is more standardized and easy to promote and teach: The entire operation process has clear positioning references and standardized operation steps. The logic is clear, the difficulty of getting started is low, and the operation is highly repeatable, making it suitable for large-scale and standardized training of laparoscopic anastomosis skills.

[0062] It will be apparent to those skilled in the art that the present invention is not limited to the details of the exemplary embodiments described above, and that the invention can be implemented in other specific forms without departing from its spirit or essential characteristics. Therefore, the embodiments should be considered in all respects as exemplary and non-limiting, and the scope of the invention is defined by the appended claims rather than the foregoing description. Thus, all variations falling within the meaning and scope of equivalents of the claims are intended to be included within the present invention. No reference numerals in the claims should be construed as limiting the scope of the claims.

[0063] Furthermore, it should be understood that although this specification describes embodiments, not every embodiment includes only one independent technical solution. This narrative style is merely for clarity. Those skilled in the art should consider the specification as a whole, and the technical solutions in each embodiment can also be appropriately combined to form other embodiments that can be understood by those skilled in the art.

Claims

1. A training method for laparoscopic esophagojejunostomy, characterized in that, This method is used for training in handling ex vivo digestive tract specimens and includes the following steps: S1, Obtain isolated digestive tract specimens, wherein the isolated digestive tract specimens include isolated esophagus and isolated jejunum; S2, the guiding support device is pressed against the predetermined cutting point in the central region of the isolated esophagus through the lumen of the isolated esophagus, and the isolated esophagus is cut open in its entirety at the predetermined cutting point to form an opening of the isolated esophagus; S3, one arm of the linear anastomosis device is inserted into the opening of the isolated jejunum, and the other arm is inserted into the lumen of the isolated esophagus through the opening of the isolated esophagus. The linear anastomosis device is then fired to form an anastomosis between the isolated esophagus and the isolated jejunum. The isolated esophagus is positioned above the isolated jejunum, and the common opening at the anastomosis site is located in the central region of the isolated esophagus stump. S4, using the isolated esophageal stump as a suture positioning marker, the isolated jejunal wall and the isolated esophageal wall are continuously sutured together with sutures to close the common opening; S5, using the same suture to reinforce the seromuscular layer of the cut line of the isolated esophageal stump formed in step S2, the anastomosis line formed in step S3, and the common opening closure line formed in step S4.

2. The method according to claim 1, characterized in that, In step S2, the guiding support device is a rigid nasogastric tube, which is used to press down on the isolated esophageal stump and guide the incision.

3. The method according to claim 1, characterized in that, In step S2, the predetermined incision point is located in the central region of the posterior wall of the detached esophageal stump and is adjacent to the staple line of the detached esophageal stump.

4. The method according to claim 3, characterized in that, In step S2, the predetermined cutting point is 2-3 mm away from the staple line.

5. The method according to claim 1, characterized in that, In step S2, after the full-thickness incision is completed, the guiding support device is further advanced so that its distal end protrudes outward through the opening of the isolated esophagus, causing the edge of the isolated esophageal mucosa to evert and converge towards the center, forming a flat mucosal edge that is not easy to retract.

6. The method according to claim 2, characterized in that, In step S3, the other arm of the linear anastomosis device is inserted into the lumen of the isolated esophagus through the opening of the isolated esophagus under the guidance of the rigid nasogastric tube.

7. The method according to claim 1, characterized in that, In step S4, when closing the common opening, the outer edge of the isolated esophageal stump is used as a reference. The suture needle passes through the serosa, muscle layer and mucosa of the isolated esophagus in sequence, and penetrates the entire layer of the corresponding isolated jejunal wall.

8. The method according to claim 1, characterized in that, In step S5, the seromuscular layer reinforcement adopts horizontal mattress suture. First, one side of the residual angle of the detached esophageal stump is buried, and the seromuscular layer is sutured along the common opening closure line. Then, the other side of the residual angle is buried, and finally the anastomosis is rotated to reinforce the anastomosis line.

9. The method according to claim 1, characterized in that, In step S5, the same suture is a barbed suture.

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