Gallagher A G, McClure N, McGuigan J, Crothers I, Browning J
Queen's University Centre for Endoscopic Training and Research, Queen's University, Belfast, Northern Ireland.
Endoscopy. 1999 May;31(4):310-3. doi: 10.1055/s-1999-15.
The "fulcrum effect" of the body wall on surgical instrument manipulation is a major hurdle for novice endoscopic surgeons. Virtual reality training has not previously been evaluated as a means to overcome this problem.
16 participants with no experience of endoscopy were required to make multiple defined incisions under laparoscopic laboratory conditions within 2-minute periods. Half of the subjects were randomized to receive initial training on the Minimally Invasive Surgical Trainer, Virtual Reality (MIST VR) computer programme.
Participants with MIST VR training made significantly more correct incisions (P = 0.0001) than the control group on test trial 1, and even after extended practice by both groups (P = 0.0001). They were also significantly more likely to actively use both hands to perform the endoscopic evaluation task (P = 0.01).
Virtual reality training represents a potential, viable solution for junior endoscopists, for overcoming the "fulcrum effect", in a replicable, safe learning environment which allows objective and reliable quantification of skill levels by trainers.
体壁对外科手术器械操作的“支点效应”是初窥内镜手术的外科医生面临的主要障碍。此前，虚拟现实训练尚未作为克服这一问题的手段进行评估。
16名无内镜检查经验的参与者被要求在腹腔镜实验室条件下，在2分钟内进行多次规定切口操作。一半受试者被随机分配接受虚拟现实微创外科训练器（MIST VR）计算机程序的初始训练。
接受MIST VR训练的参与者在测试试验1中做出的正确切口明显多于对照组（P = 0.0001），即使在两组都进行了长时间练习后仍是如此（P = 0.0001）。他们也更有可能积极使用双手来完成内镜评估任务（P = 0.01）。
虚拟现实训练为初级内镜医师提供了一种潜在的、可行的解决方案，可在可复制、安全的学习环境中克服“支点效应”，使培训师能够对技能水平进行客观可靠的量化。
