泌尿外科腹腔镜技术阶梯式教学模式研究与实践

目的探讨泌尿外科腹腔镜技术阶梯式教学的效果。方法选取2015年12月至2016年6月在医院实习的120名我校医学生,了解其腹腔镜掌握情况,针对不同学情的实习生,采用多媒体教学、模拟器训练、活体动物模拟手术、观看手术录像及协助完成真实病例的阶梯式训练。结果所有医学生均能熟悉腹腔镜及配套设备的结构和性能,了解腹腔镜工作原理,掌握腹腔镜基本操作技能,并可在上级医生指导下完成后腹腔镜肾切除术或肾上腺腺瘤切除术等常规手术,达到预期的教学目标。结论根据泌尿外科实习学生的实际情况,针对性地开展腹腔镜技术阶梯式教学,效果显著,值得推广应用。     

阶梯式教学法在腹腔镜基本技术培训教学中的应用

腹腔镜技术作为最主要的微创技术在外科领域得到广泛应用,是普通外科医生必须掌握的一项技能。但腹腔镜手术与开放手术不同,具有一定难度,必须经过学习和培训才能在实践中逐渐掌握。阶梯式教学法具有循序渐进、针对性强、目标明确、环环相扣等优点,在教学实践中得到了较好应用。根据腹腔镜手术的特点和规律设计的三个阶梯的阶梯式教学法,学员能更好地学习腹腔镜的基本技术。     

关于虚拟及模拟技术在基层泌尿外科医师腔镜外科技能培训中的一些体会

针对探讨如何加强基层泌尿外科医师腔镜外科技能,结合实际教学经验,浅析通过腔镜虚拟及模拟设备和模拟训练以充分提高泌尿外科进修医生腔镜手术技能技巧,为基层医疗队伍培养综合素质高,业务水平强,掌握现代手术技术的高级泌尿外科临床医师,促进基层泌尿外科事业发展,保证基层医疗质量和水平.     

仿真腹腔镜培训系统在普外科技能教学中的应用

目的　研究虚拟仿真腹腔镜培训系统对不同临床经验培训者腔镜手术基本技能的培训效果。方法　研究分为３组,进修医生组、住院医师规范化培训组及五年制临床本科实习医生组,每组8人,分别接受腹腔镜训练箱和虚拟仿真腹腔镜培训系统镜下各项操作,每天训练30 min,共4周。比较各组之间及训练前后各组得分,采用SPSS 19.0进行t检验。结果　培训前,临床本科实习医生镜下各项操作与住院医师规范化培训组及进修医生相比差异有统计学意义（P<0.05）,经过4周培训,各组参与者培训后在各培训项目上得分和时间均较培训前明显提高（P<0.05）。简单技能操作各组间差异无统计学意义（P>0.05）;复杂技能操作临床本科实习医生组得分优于住院规范化培训组、进修医生组,差异有统计学意义（P<0.05）。结论　虚拟仿真腹腔镜培训系统可以提高不同层次临床培训者的腹腔镜基本操作技能,值得在各级临床技能教学中应用推广。     

妇科腹腔镜医师的规范化培训

腹腔镜是一门新兴的外科技术,腹腔镜手术的手术途径、设备、器械等与传统手术相差甚远．由此衍生了腹腔镜手术全新的观念与手术技巧,在普通妇科医生向内镜妇科医生转变的过程中,必须要掌握必要的技术,完成观念的更新。腹腔镜下手术操作有其独特的特点：看盆腔脏器“不便”、手眼配合“不便”、手脚配合“不便”设备操作“不便”、器械操作“不便”。腹腔镜手术技能规范化培训是内镜医生成长过程中重要的一环,根据其手术的难度分为四级,受训者应由易到难,逐步掌握。培训方式有短期培训、专项进修学习和导师指导等形式；培训内容包括理论授课和技能训练两个方面,通过模拟操作熟练掌握腹腔镜下的组织分离、结扎、缝合、止血等四大基本功。     

腹腔镜手术基本技能的实验教学实践与探索

探讨腹腔镜手术基本技能教学在临床医学生中的应用及方法;采用模拟训练、离体动物肝胆操作、活体动物试验、观看手术录像等项目进行腹腔镜手术基本技能训练;使学生能熟悉腹腔镜及配套设备的结构和性能,初步掌握基本操作技能,培养了腹腔镜手术技能训练的兴趣,激发了学生的学习热情,通过实践证明在临床医学生中开展腹腔镜手术基本技能的实验教学是有效和可行的。     

腹腔镜操作模拟训练系统用于手术基本技能训练的研究

目的探讨腹腔镜模拟训练系统对不同操作组腹腔镜手术基本技能的培训效果。方法临床培训医生组,本院进修医生无腹腔镜操作经验组,临床本科五年制的实习医生组,分别使用腹腔镜模拟训练系统练习镜下夹取药丸、剪纱布、缝合及器械打结技术,每天训练90分钟共2周,比较培训前后各组得分。结果培训前,本科实习生夹取药丸、剪纱布、缝合技术及器械打结技术明显不如临床培训医师及进修医师（P〈0.05）,经过2周培训,较简单的技能操作如夹药丸、剪纱布和临床培训医师及进修医师无统计学差异（P〉0.05）;3组人员训练后与训练前相比,腹腔镜的基本技能操作均显著提高（P〈0.05）。讨论腹腔镜模拟训练系统可以提高不同临床经验参与者的腹腔镜操作技能,值得推广。     

泌尿外科腹腔镜技能培训中动物模型的应用

目的 探讨泌尿外科腹腔镜技能培训中动物模型的临床应用价值.方法 2009年5月-2011年6月,我院6名临床实践经验相当的青年泌尿外科医生接受了动物模型上开展腹腔镜下肾盂成形术的技能培训,对培训效果做总结分析.结果 6名医生培训前手术平均出血量和手术时间差异没有统计学意义(p＞0.05),培训后手术平均出血量和手术时间没有统计学院差异(p＞0.05);但是培训前、后每位医生的手术平均出血量和手术时间比较有统计学差异(p＜0.05).结论 动物模型上进行腹腔镜下泌尿外科手术的培训,能显著提高医生的手术技能,提高手术成功率、减少手术并发症,安全、可靠、有效,适用于大多数的泌尿外科医生,值得临床推广.     

“六位一体”腹腔镜手术培训模式在泌尿外科教学中的应用研究

探索针对多阶段青年医生（包括实习生、规培生、进修生）的泌尿外科“六位一体”腹腔镜手术培训模式。实践证明,所有阶段青年医生均能达到该阶段培养目标,筑牢腹腔镜操作基础,完成泌尿外科基本的腹腔镜手术操作。相较于传统模式,“六位一体”腹腔镜手术培训模式培养的学员能更快更好地完成腹腔镜基本手术,具有推广意义。     

腹腔镜下子宫切除术的现状和新进展

1腹腔镜下子宫切除术的定义和分类 1991年德国医生Semm完成了首例腹腔镜下子宫切除术(Laparoscopic hysterectomy,LH),此后不同的手术方式在手术器械的设计、应用和手术医生技巧提高的同时得到逐步发展.     

上尿路微创手术的技术改良

Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it’s important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as “4TB principals”, which include “tension-free”, “water-tight”, “thin suture”, “no touch of the key area” and “protecting the blood supply”. Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.     

腹腔镜基本技能的模拟训练

腹腔镜基本技能的培训是微创外科发展的必然要求,哈尔滨医科大学附属第四医院微创外科针对从事微创外科的医务工作者,通过讲解有关腹腔镜基本理论知识,并与模拟训练和手术观摩等方式相结合,教法灵活,使学员真正掌握这门微创技术。     

膝关节镜手术仿真训练系统应用效果评估

目的分析应用膝关节镜手术仿真系统对关节镜手术培训的效果,进行量化评估并合理优化培训方法。方法将40余名进修医师分为两组进行对照实验,对照组只进行普通教学,实验组在普通教学基础上参加虚拟仿真训练;并对实验组内高职学员与中职学员参加不同仿真训练的效果进行比较。结果通过两组学员3次手术得分差别,发现经过仿真培训得分差别较为明显（P1=0.4;P2=0.02;P3〈0.001）;而通过比较实验组内高职学员和中职学员完成不同模拟操作用时及错误次数,发现不同职称学员对同一操作掌握的进度不同。结论膝关节镜手术仿真训练系统能有效提高手术技能培训效果,制订培训计划和学习策略应按照参训学员不同年资分别对待。     

Laparoscopic simulators : Are they useful!

Background: Laparoscopic surgery has changed the face of medical care forever. The benefits of laparoscopic open surgery have been demonstrated in virtually all major abdominal surgical procedures. Laparoscopy has introduced a new skill set that must be mastered and requires dedicated training. The teaching of laparoscopic operative skills in the clinical setting is constrained by the complexity of procedures, medicolegal and ethical concerns, fiscal and time limitations. This has created the need for formal training outside the operating room. Simulator-based training holds great promise in enhancing surgical education and providing a safe, cost-effective means for practicing techniques prior to their use in the operating room.     

Virtual Laparoscopic Training System Based on VCH Model

Laparoscopy has been widely used to perform abdominal surgeries, as it is advantageous in that the patients experience lower post-surgical trauma, shorter convalescence, and less pain as compared to traditional surgery. Laparoscopic surgeries require precision; therefore, it is imperative to train surgeons to reduce the risk of operation. Laparoscopic simulators offer a highly realistic surgical environment by using virtual reality technology, and it can improve the training efficiency of laparoscopic surgery. This paper presents a virtual Laparoscopic surgery system. The proposed system utilizes the Visible Chinese Human (VCH) to construct the virtual models and simulates real-time deformation with both improved special mass-spring model and morph target animation. Meanwhile, an external device that integrates two five-degrees-of-freedom (5-DOF) manipulators was designed and made to interact with the virtual system. In addition, the proposed system provides a modular tool based on Unity3D to define the functions and features of instruments and organs, which could help users to build surgical training scenarios quickly. The proposed virtual laparoscopic training system offers two kinds of training mode, skills training and surgery training. In the skills training mode, the surgeons are mainly trained for basic operations, such as laparoscopic camera, needle, grasp, electric coagulation, and suturing. In the surgery-training mode, the surgeons can practice cholecystectomy and removal of hepatic cysts by guided or non-guided teaching.     

后腹腔镜辅助下小切口上尿路手术26例分析

目的：探讨后腹腔镜辅助下小切口上尿路手术的方法。方法：对26例泌尿外科疾病的患者行后腹腔镜辅助下无气腹小切口上尿路手术,并观察其疗效。结果：24例手术成功,2例肾结核因粘连严重而将切口延长为常规切口。24例患者术中均未输血,未发生任何手术并发症。结论：后腹腔镜辅助下小切口上尿路手术与后腹腔镜肾切除术和后腹腔镜离段性肾盂成形术相比,该手术方法无需充气,可使用普通的手术器械,操作方便且不增加手术创伤。     

腹腔镜手术高级技能培训的探索

针对目前腹腔镜手术高级技能培训存在的不足,通过设计桔子解剖法、离体腹腔镜手术模型等培训方法,集中训练学员精细的组织分离技术、高难度的缝合打结技术等腹腔镜高级手术技能。与传统的培训方法相比,新的培训方法可以明显地提高学员的腹腔镜手术高级技能。腹腔镜高等技巧的集中训练非常有益处,可以整合入腹腔镜的培训课程中。     

腹腔镜手术示教系统的建立与应用

腹腔镜已在外科临床手术中得到广泛应用,建立腹腔镜手术示教系统为手术技能培训提供了先进的教学手段。笔者结合我院该系统的建立和应用探讨具体的建设和实用方法。     

Laparoscopic Simulators : Are They Useful!

Background

Laparoscopic surgery has changed the face of medical care forever. The benefits of laparoscopic open surgery have been demonstrated in virtually all major abdominal surgical procedures. Laparoscopy has introduced a new skill set that must be mastered and requires dedicated training. The teaching of laparoscopic operative skills in the clinical setting is constrained by the complexity of procedures, medicolegal and ethical concerns, fiscal and time limitations. This has created the need for formal training outside the operating room. Simulator-based training holds great promise in enhancing surgical education and providing a safe, cost-effective means for practicing techniques prior to their use in the operating room.

Methods

The surgical residents of two batches were recruited for the study. The residents were randomized to either a group that received training on a simulator or a controlled group that did not receive the training or to a group that received training twice.

Result

The residents who received training on a simulator demonstrated better psychomotor skills in the operation theatre than those who did not. Training in simulator environment can contribute to the development of technical skills relevant to the performance of laparoscopic surgery in vivo. Training at regular intervals will benefit the residents in gaining significant improvement of their psychomotor skills.

Conclusion

Laparoscopic trainer is a promising tool for training in laparoscopic surgery.Key Words: Laparoscopic simulator, Endotrainer, Training, Laparoscopic surgery     

单孔腹腔镜技术在妇科恶性肿瘤中的应用体会

单孔腹腔镜技术因其创伤小、美观和恢复快等优点而应用于妇科良恶性肿瘤手术中。本文简述了单孔腹腔镜技术在妇科恶性肿瘤手术中的发展历程、优势与局限性,并对手术适应证和关键技术进行综述,展望了单孔腹腔镜技术以及机器人辅助下单孔腹腔镜技术在未来的发展前景。