2026/03/13 by E. Roussel, Edouard Roussel, Christophe Arnoult +9 · 1 citation
Medicine · Nursing · #Clinical Nutrition and Gastroenterology #Minimally Invasive Surgical Techniques #Surgical Simulation and Training
paper · doi:10.1097/xcs.0000000000001906
openalex publication_date 2026/03/13 · openalex created_date 2026/03/14 · openalex updated_date 2026/07/31
BACKGROUND: Live porcine models remain central to advanced surgical training but raise ethical, logistical, and cost concerns under the 3R (replacement, reduction, refinement) framework. Scalable ex vivo alternatives that preserve realism while maintaining food-chain compliance are lacking. STUDY DESIGN: We conducted a prospective proof-of-concept study evaluating an ex vivo perfused porcine thoracoperitoneopelvic visceral monobloc harvested from a slaughterhouse using an industry-adapted technique preserving carcass reintegration into the food supply chain. The monobloc was cannulated, frozen, thawed, and integrated into a reusable 3-dimensional-printed humanoid mannequin with pulsatile saline perfusion. Sixteen surgical residents (2 years or more experience) participated in four full-day simulation sessions using open and laparoscopic approaches. The primary endpoint was perceived realism measured on 5-point Likert scales. Secondary endpoints included preparation time, reproducibility, and approximate production cost. RESULTS: Overall satisfaction (5.0 ± 0.0) and perceived educational value (4.9 ± 0.8) were high. Tissue haptics (4.9 ± 0.3), dissection realism (4.4 ± 0.5), and instrument handling (4.6 ± 1.0) were rated favorably, whereas perfusion and hemorrhage realism was lower (2.6 ± 1.2). Of 8 monoblocs prepared, 4 achieved successful revascularization; these were rated 4.0 ± 0.0 for perfusion realism. Mean harvesting and preparation times were 16.3 ± 4.8 and 15.7 ± 4.4 minutes, respectively; mannequin setup required ~45 minutes. Cost was €100 per monobloc, with initial infrastructure less than €1,000. The model supported open, laparoscopic, and robotic procedures across multiple specialties. CONCLUSIONS: This low-cost, food-chain-compliant ex vivo perfused porcine model demonstrates high perceived realism for open and minimally invasive training while reducing reliance on live animals. Revascularization reliability and external validation against in vivo models are required before large-scale implementation.