不同年龄医生应用腹腔镜模拟训练器的效果分析

目的 探讨不同年龄段医生参与腹腔镜模拟训练器的培训效果.方法 按年龄分3组,每组10人,低龄组(年龄≤25岁)、中龄组(年龄＞25 ～≤35岁)和大龄组(年龄＞35 ～≤45岁).训练内容为腹腔镜下夹取黄豆、剪切图形和缝合打结训练,分别在训练前、训练3次、训练6次记录1 min内的拾豆数,剪切一个几何图形所需的时间及10 min内的缝合打结数,各计数3次,取平均值.结果 训练前3组夹取黄豆数分别为(9.2±1.7)、(10.2±1.2)、(9.0±1.4)个/min,无统计学差异(F=1.97,P=0.159),训练3次后低龄组1 min夹豆数(17.2±2.1)个/min明显多于中龄组(14.2±1.9)个/min(q=5.342,P ＜0.05)和大龄组(11.3±1.2)个/min(q=10.507,P＜0.05),中龄组明显多于大龄组(q=5.164,P＜0.05);训练6次后3组比较无统计学差异(F=2.27,P=0.123).训练前3组剪裁几何图形所需时间分别为(11.2±1.6)、(10.2±1.2)、(10.2±1.2)min,无统计学差异(F=1.84,P=0.178),训练3次后低龄组剪裁几何图形所需时间(5.2±1.1)min明显少于中龄组(8.2±1.3)min(q =8.105,P＜0.05)和大龄组(11.2-1.1)min(q =16.210,P＜0.05),中龄组明显少于大龄组(q=8.105,P＜0.05),训练6次后3组比较有统计学差异(F=62.80,P=0.000)).训练前3组缝合打结数分别为(1.9±0.3)、(2.2±1.2)、(2.5±1.4)个/10 min,无统计学差异(F=0.77,P=0.471),训练3次后低龄组10 min缝合打结数(8.9±1.2)个/10 min明显多于中龄组(5.1±1.6)个/10 min(q =8.924,P＜0.05)和高龄组(4.3±1.2)个/10 min(q=10.802,P＜0.05),训练6次后3组比较有统计学差异(F=35.76,P=0.000).3组在训练前后1 min夹豆数、剪裁几何图形所需时间、10 min缝合打结数均有统计学差异(P＜0.05).结论 腹腔镜模拟训练可以提高不同年龄参与者的腹腔镜操作技巧,年纪越轻培训的优势越明显.     

腹腔镜基础技能模拟训练的量化研究

目的比较医学生和外科低年资住院医师在腹腔镜基础技能模拟训练中的差异,为腹腔镜基础技能训练提供客观的数据。 方法通过比较医学生和低年资医师在传递、精确定位、剪切、打结及缝合打结项目中的操作时间和失误情况得分的差异,建立各自的学习曲线。 结果经过10次训练后,A、B组参与者在传递、精确定位、剪切、打结及缝合打结5个项目的得分分别是(89.81±2.07) vs(93.91±3.46)、(89.00±6.39) vs(91.21±6.69)、(84.35±5.94) vs(86.69±6.46)、(93.88±3.01) vs(93.51±2.65)、(87.34±3.22)vs (92.09±4.10)。A、B组参与者的精确定位、剪切、打结的训练结果之间无差异(P >0.05),而传递和缝合打结的训练结果之间存在统计学差异(P<0.05)。A、B组参与者在同一训练项目中第1次与第10次的训练结果之间存在差异(P<0.05)。A、B组参与者在传递、打结和缝合打结项目中呈反曲线发展,而在精确定位和剪切两个项目中呈线性发展。 结论通过训练,A、B组参与者的腹腔镜基础技能均获得显著提高,重复性的训练可以使A组在精确定位、剪切、打结的训练中达到B组的水平,A、B组参与者在传递、打结和缝合打结项目中已达到平台期,而在精确定位和剪切两个项目中仍处于增长期。     

重视腹腔镜下动物组织模拟训练在腹腔镜培训中的作用

目的 探讨腹腔镜下动物组织模拟训练在外科学研究生腹腔镜技能培训中的作用.方法 2010年11月10日至2010年12月31日期间于中山大学各附属医院招收外科学研究生共48人,举办培训班3期,每期培训16人,每期培训12d,平均每人每天训练4h.培训内容包括腹腔镜基础理论学习、模拟操作训练、腹腔镜下动物组织(猪大肠)操作训练、手术观摩学习、模拟动物训练.在三期培训过程中对体外模拟箱操作训练和腹腔镜下动物组织(猪大肠)操作训练进行不同时间的分配,最后考核在腹腔镜下缝合与打结用时,用以比较在不同培训方法下培训效果之间的差异.结果 三期不同临床经验的研究生在接受培训后,完成拾豆、拆套橡皮筋及穿鞋带等操作的培训后用时比培训前用时明显减少,差异有统计学意义(P＜0.05).在不同的培训时间分配下,腹腔镜下猪大肠操作训练时间较多的第2期、第3期学员在培训后动物实验中腹腔镜下缝合与打结用时较分配时间少的第1期学员明显减少,差异有统计学意义(P＜0.05),而第2期与第3期相比无显著差异.结论 重视腹腔镜下动物组织模拟操作训练可提高腹腔镜培训的效果,值得推广.     

单孔腹腔镜体外缝合训练模式的探索

目的探索适合体外缝合训练的模拟操作箱、入路平台(port)及缝合方式。 方法由1位有单孔腹腔镜操作经验的手术医师采用改良腹腔镜模拟训练箱进行缝合操作。缝合方式包括单手法和双手法,缝合目标包括固定目标和活动目标。以不使用port作为对照,比较2种缝合方式在4种不同的port中缝合30针所需的时间。另5位有多孔、无单孔腹腔镜操作经验的医师接受缝合训练,采用无port缝合活动目标,每次训练缝合30针,每周1次,记录分析缝合时间。 结果采用经改良的常规腹腔镜模拟箱可顺利完成缝合训练。缝合固定目标时,单手法耗时明显少于双手法(P<0.05)。缝合活动目标时,双手法耗时明显少于单手法(P<0.05)。较大port的缝合耗时较久。训练阶段缝合时间前3次逐步缩短[(16.5±0.2)s、(13.4±0.3)s、(12.0±0.1)s](P<0.05),第4、5次[(12.3±0.2)s、(12.3±0.2) s]与第3次比较,差异无统计学意义(P>0.05)。 结论采用改良的常规腹腔镜模拟操作箱、无需port可完成单孔腹腔镜缝合训练。训练过程需强调单手操作,较大port不适合单孔下的训练,平均3次训练可完成体外缝合的学习曲线。     

腹腔镜模拟教学培训体系在临床教学中的应用研究

目的:探讨腹腔镜模拟教学培训体系在临床教学中的应用价值及效果评价。方法:随机抽取2018年9月～11月参加山东省住院医师规范化培训的30位外科专业医师,培训前均未接触过腹腔镜技术。对比应用腹腔镜模拟教学培训体系培训前后住院医师的理论知识及腔镜模拟训练操作情况。腹腔镜模拟训练操作包括镜下精确定位训练、递接操作及缝合打结等,对每位住院医师的腹腔镜操作进行计时、计数,连续培训8周后,分别测试培训后上述各项技能完成情况,比较操作时间及熟练程度。结果:参加腹腔镜模拟教学培训前,腹腔镜基础理论分为(43.80±4.39),经过培训后分值提至(85.76±6.37)。腹腔镜模拟操作时间培训后较培训前缩短,其中腹腔镜下精确定位训练[(196.3±60.5)s vs.(93.7±15.6)s]、递接操作[(126.3±43.2)s vs.(73.7±19.5)s]、缝合打结操作[(465.3±90.5)s vs.(186.7±31.6)s]水平显著提升,差异有统计学意义。结论:应用腹腔镜模拟教学培训体系培训外科住院医师可提高其操作技能,且随着培训时间的延长,操作技能得到持续提升,操作时间缩短。     

腹腔镜模拟培训在外科住院医师规范化培训中的应用

目的:探讨腹腔镜模拟训练在外科住院医师规范化培训中的应用效果。方法:选取2018年12月至2019年11月进行腹腔镜模拟培训的外科住培医师57人次，共举办三期培训班。培训内容包括在腹腔镜模拟器下缝合、打结、剪纸环、拾豆转移等项目，分别测试外科住培医师在三期腹腔镜培训后上述4项技能的完成效果。结果:三期腹腔镜模拟培训班均顺利完成，达到预定的培训目标。培训前后住院医师完成缝合、打结、剪纸环、拾豆转移4项技能的时间少于培训前，差异均有统计学意义(P<0.05)。结论:规范化的腹腔镜模拟培训符合腹腔镜手术的特点，可提高外科住培医师的腹腔镜培训效果，值得推广。     

314名泌尿外科医师腹腔镜模拟培训效果分析

目的:评价泌尿外科医师腹腔镜模拟培训效果。方法:2011年3月～2012年3月314名26～53岁泌尿外科医师参加腹腔镜模拟培训,在腹腔镜模拟机和训练箱进行腹腔镜手术基本技能培训前后进行问卷调查,并比较培训前后模拟机客观评分和综合评估量表(GRS)评分结果。结果:其中86名泌尿外科医师经3天腹腔镜模拟培训后,电钩练习时间、剪切时间、缝合打结(方结)时间较培训前明显缩短(P<0.01),电凝效率、GRS明显提高(P<0.01)。反馈调查结果显示279名(97.6%)受训者认为模拟培训对提高腹腔镜操作能力帮助明显或非常有帮助。结论:腹腔镜模拟培训可帮助泌尿外科医师提高腹腔镜基本操作技能。     

面向规培生的腹腔镜基本技能培训体系的应用研究

目的:尝试构建完整的腹腔镜基本技能培训体系，并评估其对外科学初级医学生的培训效果。方法:随机抽取2022年10月至12月参加住院医师规范化培训的50名临床医师，均为低年资住院医师，未接受正规腔镜培训。对比培训前后规培生腹腔镜相关理论及技能操作掌握情况。培训及考核内容包括拾豆训练、插针训练、翻纸训练、缝合打结训练、剪切训练五项，采用腹腔镜手术标准化评估标准评分，对比培训前后操作熟练程度。结果:1年组的规培学员培训后，拾豆、插针、翻纸、剪切四项训练效果得到明显提升，但缝合打结训练中，≥3年组学员成绩提升更为明显，且学员成绩随培训时间增加呈明显上升趋势。结论:腹腔镜基本技能培训对住培医生腔镜技能提升效果显著，不同工作年限对培训效果影响不大，住培生早期开展腹腔镜基本技能规范化培训是非常必要的。     

应用单环刺螠模拟训练腹腔镜输尿管切开取石术的研究

目的研究单环刺螠模型在输尿管切开取石缝合的腹腔镜训练中应用的可行性。方法采用单环刺螠制作成输尿管结石模型,将之固定于腹腔镜全景式模拟箱中。2016年4月至10月,对5位完成腹腔镜基本技能培训但无实际腹腔镜手术经验的临床泌尿外科年轻医师进行输尿管切开取石缝合的模拟训练,其中模拟缝合的方式包括3种,每种方式各完成10轮。记录每次手术的完成时间,并根据每次手术术中缝合撕裂针数、术后检查吻合口针距及边距的情况、缝合后输尿管的水密性,累计成手术的失误评分,对吻合口质量进行初步评估。结果 5位年轻医师成功完成了所有输尿管切开取石缝合的培训,不管是应用何种输尿管切口缝合方式,最后结束培训时所用的手术时间均较最初时明显缩短,而缝合失误评分也较最初时明显降低,差异均有统计学意义(P0.05)。结论腹腔镜输尿管切开取石缝合技能需要有效的训练和不断的实践来完善。单环刺螠模型是一种很好的输尿管切开取石缝合的训练材料,这种训练缩短了临床泌尿外科年轻医师的学习曲线,并提高了他们的手术操作技能。     

自制简易腹腔镜模拟器的探讨

应用计算机、摄像头、纸箱、腹腔镜器械等组成简易腹腔镜模拟器，对36名实习医生（均无腹腔镜技术）分成实验组（n=18）及对照组（n=18），组内再按性别分组，进行腹腔镜技术测试。实验组应用此模拟器，训练打结技术；对照组用传统外科器械训练打结。2组均每天练习30min，4周后同时在腹腔镜下打结，测试打结的数量。实验组30min打结数量明显多于对照组（t=8．830，P=0.000）；实验组外科结质量优于对照组（t=-2．603．P=0．014）。我们认为利用简易腹腔镜模拟器训练有助于提高临床医生腹腔镜技术水平。     

Evaluation of laparoscopic skills: a 2-year follow-up during residency training.

OBJECTIVE: To evaluate laparoscopic technical skill in surgical residents over a 2-year period. DESIGN: The laparoscopic technical skills of general surgical residents were evaluated using the MISTELS program. This provides an objective evaluation of laparoscopic skill, taking into account precision and speed. SETTING: Inanimate laparoscopic skills centre. PARTICIPANTS: Ten general surgical residents (5 PGY1, 3 PGY2 and 2 PGY3 residents) who were required to complete 3 structured laparoscopic tasks. OUTCOME MEASURES: A composite score incorporating precision and timing was assigned to each task. The paired t-test was used to compare performance of each resident at the 2 levels of their residency training for each task. Linear regression analysis was used to correlated level of training and total score (sum of all tasks). RESULTS: Linear regression analysis demonstrated a highly significant correlation between level of training and total score (r = 0.82, p < 0.01). There was a significant increase in scores in the cutting and suturing task over the 2-year period (p < 0.01). Transferring skills did not improve significantly (p = 0.11). CONCLUSIONS: Performance in the simulator improved over residency training and was correlated highly with postgraduate year. This simulator model is a valuable teaching tool for training and evaluation of basic laparoscopic tasks in laparoscopic surgery.     

Prospective randomized controlled trial of laparoscopic trainers for basic laparoscopic skills acquisition

Background Laparoscopic surgery requires a different set of skills than traditional open surgery. The acquisition of basic laparoscopic skills may help novices when learning laparoscopic procedures. This study tested the hypothesis that the combination of virtual reality and box trainers leads to better basic laparoscopic skill acquisition than either method alone or no training. Methods A randomized control trial involving preclinical medical students with no prior operative experience was performed. The students were grouped according to four training methods: virtual reality training, inanimate box training, a combination of both, and no training (control). The pre- and posttraining scores for four skills in the porcine laboratory were the metrics chosen for this study. Results A total of 65 students participated in this study. There were no differences among any of the pretraining scores (p > 0.05). The posttraining times differed between the four groups. Post hoc analyses showed statistically significant differences (p < 0.05) between the participants trained with both trainers and the control subjects. Conclusions Our data demonstrate that the combination of virtual reality training and inanimate box training leads to better laparoscopic skill acquisition than either training method alone or no training at all. Optimal preclinical laparoscopic training should incorporate both virtual reality trainers and inanimate box trainers. Presented in part at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting, March 2004, Denver, CO     

Technical and technological skills assessment in laparoscopic surgery.

OBJECTIVES: Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation. METHODS: Checklists for generic, specific technical, and technological skills for laparoscopic cholecystectomies were constructed. Two surgeons with >12 years postgraduate surgical experience assessed each operation blindly and independently on DVD. The technological skills were assessed in the operating room. RESULTS: One hundred operations were analyzed. Eight trainees and 10 consultant surgeons were recruited. No adverse events occurred due to technical or technological skills. Mean interrater reliability was kappa=0.88, P=<0.05. Construct validity for both technical and technological skills between trainee and consultant surgeons were significant, Mann-Whitney P=<0.05. CONCLUSIONS: Our study demonstrates that technical and technological skills can be measured to assess performance of laparoscopic surgeons. This technical and technological assessment tool for laparoscopic surgery seems to have face, content, concurrent, and construct validities and could be modified and applied to any laparoscopic operation. The tool has the possibility of being used in surgical training and appraisal. We aim to modify and apply this tool to advanced laparoscopic operations.     

Measuring laparoscopic operative skill in a video trainer

Background Laparoscopic surgery requires a unique set of technical skills. More experienced laparoscopic surgeons perform certain tasks more efficiently in a video trainer than less experienced laparoscopic surgeons. The presumption is that the experienced surgeon possesses more of the skill required to complete the task. This study sought to determine the degree to which previous laparoscopic operative experience influenced the performance of selected video trainer tasks of varying complexity. Methods In this study, 19 general surgery residents with varying levels of laparoscopic operative case experience (as defined by operative case logs) were timed performing five tasks in a video trainer. The tasks were rope pass, peg drop, peg exchange, needle pass, and knot tie. All the residents watched a video demonstration of each skill before testing. None of the residents had previous exposure to video trainers, and no practice was allowed before testing. A composite score for all tasks was calculated for each resident as a measure of overall performance. Results There was a strong correlation between operative experience and time required for successful completion of each task, with the exception of the rope pass. The magnitude of correlation increased with tasks of increasing complexity. Composite scores were correlated with operative experience. Significant interval improvements in performance were observed for increasing experience up to a level of approximately 100 previous laparoscopic cases. Conclusions Overall composite scores and time required for the completion of each individual video trainer task (with the exception of the rope pass) may be an accurate reflection of laparoscopic surgical skill acquired in the operating room. A resident may need as many as 100 laparoscopic cases for full development of a basic skill set in the operating room. A more efficient and safe method of training, such as a validated skills curriculum conducted in a dry lab, is a desirable alternative to developing skill exclusively in the operating room.     

Construct validity testing of a laparoscopic surgical simulator

BACKGROUND: We present initial data on the construct, content, and face validity of the LAPMentor (Simbionix), virtual reality laparoscopic surgical simulator. STUDY DESIGN: Medical students (MS), residents and fellows (R/F), and experienced laparoscopic surgeons (ES), with < 30 laparoscopic cases per year (ES<30) and those with > 30 laparoscopic cases per year (ES>30), were tested on 9 basic skill tasks (SK) including manipulation of 0-degree and 30-degree cameras (SK1, SK2), eye-hand coordination (SK3), clipping (SK4), grasping and clipping (SK5), two-handed maneuvers (SK6), cutting (SK7), fulguration (SK8), and object-translocation (SK9). RESULTS: Mean MS (n=23), R/F (n=24), ES<30 (n=26), and ES>30 (n=30) ages were 26 years (range 21 to 32 years), 31 years (range 27 to 39 years), 49 years (range 31 to 70 years) and 47 years (range 34 to 69 years), respectively. In the lower level skill tasks (SK3, SK4, SK5, and SK6) the ES>30, ES<30, and R/F had similar scores, but were all substantially better than the MS scores. In the higher level skill tasks (SK7, SK8, and SK9), the ES>30 scores tended to be better than the R/F and ES<30, which were similar, and these, in turn, were markedly better than the MS. The ES>30 had notably higher SK8 scores than the R/F and ES<30, who had similar scores, and these had notably better scores than the MS. CONCLUSIONS: The noncamera skills (SK3 to 9) of the LAPMentor surgical simulator can distinguish between laparoscopically naive and ES. SK8 showed the highest level of construct validity, by accurately differentiating among the MS, R/F, ES<30 and ES>30.     

A warm-up laparoscopic exercise improves the subsequent laparoscopic performance of Ob-Gyn residents: a low-cost laparoscopic trainer.

INTRODUCTION: Residents traditionally acquire surgical skills through on-the-job training. Minimally invasive laparoscopic techniques present additional demands to master complex surgical procedures in a remote 2-dimensional venue. We examined the effectiveness of a brief warm-up laparoscopic simulation toward improving operative proficiency. METHODS: Using a "Poor-Man's Laparoscopy Simulator," 12 Ob/Gyn residents and 12 medical students were allocated 10 minutes to transfer 30 tablets with a 5-mm grasper from point A to point B via laparoscopic visualization in a warm-up exercise. Participants repeated the exercise following a 5-minute pause. Mean scores, expressed in seconds/tablet, and overall improvement (percentage difference between warm-up and follow-up) were analyzed according to postgraduate standing (PGY14), dexterity skills, and pertinent vocational activities. RESULTS: Significant improvements were noted for both residents (+25%) and medical students (+29%), P<0.0001. Scores between the 2 groups, however, were not significant (P=0.677). Proficiency was not influenced by PGY standing. Interestingly, the best (8.73 sec/pill) and the worst (25 sec/pill) scores were attained by a medical student and a chief resident, respectively, suggesting the contribution of individual aptitude. CONCLUSION: A brief warm-up exercise before an actual laparoscopic surgical procedure significantly improves subsequent laparoscopic performance.     

Predictors of Technical Skill Acquisition Among Resident Trainees in a Laparoscopic Skills Education Program

BACKGROUND: Administrative and financial pressures on surgical education have created a need for efficient training curricula. Predictors of innate technical ability, which would guide the optimization of such a curriculum, are not well described. The goal of this study was to identify student characteristics predictive of innate pretraining skill level and response to training during the course of a four-week laparoscopic skills development program. METHODS: Laparoscopic skills in 35 first-year surgical residents were assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) before and after a four-week skills training program and after an interval of approximately 1 year. The correlation between trainee characteristics, including age, sex, designated surgical specialty, and laparoscopic skill level was assessed by using Pearson's correlation and paired t-test studies. RESULTS: Intake MISTELS scores showed no significant correlation to age, sex, or designated field. Interns designated for the general surgery training program had significantly higher final scores than those entering other fields (p = 0.02). There was a negative correlation between trainee age and both degree of improvement during training and final scores (p = 0.02 and 0.05). A history of video game use correlated with significantly higher initial scores and better skills retention (p = 0.03 and 0.04). CONCLUSIONS: A laparoscopic technical curriculum can achieve basic proficiency even when taught to a diverse group of trainees. Older residents beginning their surgical careers may be slower to develop technical skills. Choice of subspecialty seems to predict higher level of proficiency after completion of a skills training program among resident students.     

Training in laparoscopic suturing skills using a new computer-based virtual reality simulator (MIST-VR) provides results comparable to those with an established pelvic trainer system

BACKGROUND: We hypothesized that the Minimally Invasive Surgery Trainer (MIST-VR; VP Medical R, London, U.K.) would be as effective as the Yale Laparoscopic Skills Course in improving laparoscopic intracorporeal suturing skills. MATERIALS AND METHODS: Each student made six attempts to tie a knot laparoscopically. Students were then randomized to train on the MIST-VR for five sessions (six skills/session) or the Yale Skills for five sessions (three skills/session) over 5 days. On completion of training, all students were evaluated by a test consisting of six attempts to tie a laparoscopic knot. RESULTS: The percentage improvement in knot tying time did not differ significantly in the pelvic trainer group (30 +/- 21%) (from 443 +/- 135 to 311 +/- 137 seconds) and the MIST-VR group (39 +/- 21%) (from 409 +/- 109 to 256 +/- 140 seconds) (P = 0.308). CONCLUSIONS: The MIST-VR is equivalent to the Yale Skills Course for training in the advanced laparoscopic skill of intracorporeal suturing.     

Evaluation of specialized laparoscopic suturing and tying devices.

BACKGROUND: Laparoscopic suturing and tying constitute advanced minimally invasive surgery skills. Developing proficiency in the standard methods with needle drivers is often an arduous process. Recent advances in laparoscopic instrumentations has allowed for easier methods of suturing and tying. This study investigated the hypothesis that the use of a specialized suturing device and a specialized tying device allows inexperienced medical students to suture and tie laparoscopically. METHODS: Preclinical medical students who had not received any training in open or laparoscopic surgery were included in this investigation. Each student was given a 5-minute demonstration of a specialized suturing device and a specialized tying device. The medical students were not allowed to deploy either device before actual use. After the demonstration, each student was given the device to use in a porcine model. Times were recorded and a subjective grade was given for each student. RESULTS: Twenty medical students were involved in this study. All medical students were able to complete the task of suturing and tying. The average time to suture was 104.6 seconds and the average time to tying was 31.2 seconds. The average subjective performance grade was 90 (out of 100). CONCLUSION: Specialized devices are easy to learn and use for laparoscopic suturing and tying with minimal instruction even for inexperienced medical students. Even surgeons who are not well versed in laparoscopic surgery should be able to suture and tie with certain laparoscopic instruments.