Datta Vivek, Mandalia Mirren, Mackay Sean, Chang Avril, Cheshire Nicholas, Darzi Ara
Department of Surgical Oncology and Technology, Imperial College School of Medicine at St Mary's, and the Regional Vascular Unit, St Mary's Hospital, London, UK.
Surgery. 2002 Mar;131(3):318-23. doi: 10.1067/msy.2002.120235.
Recent attention has been directed at developing quantitative assessments of surgical skill. This study aims to demonstrate whether objectively measuring differences in manual dexterity has an impact on a simulated surgical procedure.
Six general surgical trainees performed 5 polytetrafluoroethylene graft to artery anastomoses on a vascular model by using a standardized technique. Manual dexterity was objectively measured with (1) electromagnetic motion analysis: trackers applied to the backs of hands recorded and analyzed both hand movements and procedural time and (2) 4-parameter evaluation of the final product. Outcome parameters were assessed by (1) rate of anastomotic leakage and (2) smallest cross-sectional area of the anastomosis.
The 2 objective measures of manual dexterity correlated closely (Pearson coefficient, 0.423; P <.02). Trainees with better manual dexterity scores produced better outcome measures. Those with better motion analysis scores produced anastomoses that leaked less (Pearson coefficient, 0.514; P <.01) and those with higher global evaluation scores had a larger anastomotic cross-sectional area (Pearson coefficient, 0.495; P <.01). Time taken for the procedure did not appear to influence either outcome measure.
There is a significant correlation between objective measures of manual dexterity and the outcome measures in this model. This suggests that the outcome of a procedure can be predicted by measuring surgical skill.
近期注意力已转向开发手术技能的定量评估方法。本研究旨在证明客观测量手部灵巧性差异是否会对模拟手术操作产生影响。
六名普通外科住院医师使用标准化技术在血管模型上进行5次聚四氟乙烯移植物至动脉的吻合术。通过以下方式客观测量手部灵巧性：（1）电磁运动分析：将追踪器应用于手背，记录并分析手部动作和手术时间；（2）对最终产品进行四参数评估。通过以下方式评估结果参数：（1）吻合口漏血率；（2）吻合口最小横截面积。
两种手部灵巧性的客观测量方法密切相关（皮尔逊系数为0.423；P<.02）。手部灵巧性得分较高的住院医师产生了更好的结果测量值。运动分析得分较高的人所做的吻合口漏血较少（皮尔逊系数为0.514；P<.01），整体评估得分较高的人吻合口横截面积较大（皮尔逊系数为0.495；P<.01）。手术所用时间似乎并未影响任何一项结果测量值。
在该模型中，手部灵巧性的客观测量方法与结果测量值之间存在显著相关性。这表明可以通过测量手术技能来预测手术结果。
