Wilhelm David M, Ogan Kenneth, Roehrborn Claus G, Cadeddu Jeffery A, Pearle Margaret S
Department of Urology and The Southwestern Center for Minimally Invasive Surgery, The University of Texas Southwestern Medical Center at Dallas, 75390-9110, USA.
J Am Coll Surg. 2002 Nov;195(5):675-81. doi: 10.1016/s1072-7515(02)01346-7.
The objective of this study was to evaluate the effect of supervised training using a state-of-the-art virtual reality (VR) genitourinary endoscopy simulator on the basic endoscopic skills of novice endoscopists.
We evaluated 21 medical students performing an initial VR case scenario (pretest) requiring rigid cystoscopy, flexible ureteroscopy with laser lithotripsy, and basket retrieval of a proximal ureteral stone. All students were evaluated with objective parameters assessed by the VR simulator and by two experienced evaluators using a global rating scale. Students were then randomized to a control group receiving no further training or a training group, which received five supervised training sessions using the VR simulator. All students were then evaluated again in the same manner using the same case scenario (posttest).
Comparing the results of pre- and posttests, no major differences were demonstrated for any variable in the control group. In the trained group, posttest results revealed statistically significant improvement from baseline in the following parameters: total procedure time (p = 0.002), time to introduce a ureteral guidewire (p = 0.039), self-evaluation (p < 0.001), and evaluator assessment (p < 0.001). Comparing the posttest results of the control and trained arms, we found significantly better posttest scores in the trained group for the following parameters: ability to perform the task (p = 0.035), overall performance (p = 0.004), and total evaluator score (p < or = 0.001).
Students trained on the VR simulator demonstrated statistically significant improvement on repeat testing, but the control group showed no improvement. Endourologic training using VR simulation facilitates performance of basic endourologic tasks and might translate into better performance in the operating room.
本研究的目的是评估使用最先进的虚拟现实（VR）泌尿生殖内镜模拟器进行的监督训练对新手内镜医师基本内镜技能的影响。
我们评估了21名医学生进行的初始VR病例场景（预测试），该场景需要进行硬性膀胱镜检查、带激光碎石术的软性输尿管镜检查以及近端输尿管结石的篮式取出。所有学生均通过VR模拟器评估的客观参数以及由两名经验丰富的评估者使用整体评分量表进行评估。然后，学生被随机分为未接受进一步训练的对照组或接受使用VR模拟器进行五次监督训练课程的训练组。然后，所有学生使用相同的病例场景以相同方式再次进行评估（后测试）。
比较预测试和后测试的结果，对照组的任何变量均未显示出重大差异。在训练组中，后测试结果显示以下参数相对于基线有统计学上的显著改善：总操作时间（p = 0.002）、引入输尿管导丝的时间（p = 0.039）、自我评估（p < 0.001）和评估者评估（p < 0.001）。比较对照组和训练组的后测试结果，我们发现训练组在以下参数的后测试分数明显更好：执行任务的能力（p = 0.035）、整体表现（p = 0.004）和评估者总评分（p ≤ 0.001）。
在VR模拟器上接受训练的学生在重复测试中表现出统计学上的显著改善，但对照组没有改善。使用VR模拟进行腔内泌尿外科训练有助于基本腔内泌尿外科任务的执行，并且可能转化为手术室中更好的表现。
