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。

Exploration of in vitro suture training mode in laparoendoscopic single-site surgery

ObjectiveTo explore an in vitro suture-training mode in laparoendoscopic single-site surgery (LESS) with training box, different access ports and suture modes based on clinical experiences. MethodsThe suture procedure was performed by one experienced surgeon using one-handed and two-handed methods. The suture included a fixed and a mobile target. The time of 30 sutures in 4 ports was compared using the two suture methods and two targets. The control group was suture without port. The followed suture practice was finished by 5 other surgeons without LESS experience once a week without port. ResultsThe suture training was successfully completed with a modified conventional laparoscopic training box. When suturing the fixed target, the one-handed method was less time-consuming than the two-handed one (P<0.05). When suturing the mobile target, the two-handed method was less time-consuming than the one-handed one. Suture with a bigger port was more time-consuming. There was no difference in suture time with or without a port. The suture time was gradually shortened in the first 3 times [(16.5±0.2) s, (13.4±0.3) s, (12.0±0.1) s](P<0.05) and there was no statistical difference between the 4th, 5th week and the 3rd week[(12.3±0.2) s, (12.3±0.2) s](P>0.05). ConclusionsThe suture training in LESS could be conducted with a modified conventional laparoscopic training box without port. One-handed suture should be emphasized and a large port is not suitable for training. Practices once a week for 3 weeks would be appropriate for the training.