Neo Eu Ling, Patkin Michael, Watson David I
University of Adelaide Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2004 Jan-Feb;74(1-2):13-7. doi: 10.1046/j.1445-1433.2003.02886.x.
An increasingly important part of general surgical training is the development of skills in advanced laparoscopic surgery. However, this aspect of laparoscopy is not always well taught, and there is scope for improving both training and the assessment of performance. Recently, the improved affordability and accessibility of digital video technology and supporting computer systems has enabled critical analysis of operative techniques in laparoscopic surgery to be carried out inexpensively. The aim of the present project was to develop a method for the objective analysis of a laparoscopic suturing task in the real clinical environment, so that surgeon-in-training performance could be objectively evaluated.
Eight videos of laparoscopic fundoplication procedures were used and the process of posterior hiatal repair was specifically analysed. The procedures were carried out by three operators, each with a different level of advanced laparoscopic experience. Two blinded assessors independently analysed the videos in 5-s intervals at two separate sittings. Analysis concentrated on the types of movements as well as their efficiency in progressing the task.
The total time taken for the posterior hiatal repair varied between 165 and 350 s (mean 240), and the mean number of actions was 42 (range 25-55). The mean percentage of efficiency (actions deemed 'very efficient' and 'efficient'vs actions deemed fair or inefficient) was 44% overall. More experienced surgeons took less time to complete the hiatal repair and had a higher percentage of efficiency of actions than inexperienced surgeons. Inefficient or unnecessary movements could be identified; these were less common for the more experienced surgeons.
Video deconstruction enabled critical analysis of hiatal suturing in advanced laparoscopic surgery, highlighting inefficient actions. This offers a method for objectively assessing technique using readily available equipment. The method could be used to provide constructive feedback to surgical trainees.
普通外科培训中，高级腹腔镜手术技能的培养愈发重要。然而，腹腔镜手术的这一方面教学效果并非总是理想，在培训及操作评估方面仍有改进空间。近来，数字视频技术及配套计算机系统的成本降低且更易获取，使得腹腔镜手术操作技术的批判性分析能够低成本开展。本项目旨在开发一种方法，用于在真实临床环境中对腹腔镜缝合任务进行客观分析，从而能够客观评估外科住院医师的操作表现。
使用了8段腹腔镜胃底折叠术的视频，专门分析了食管裂孔后修补过程。这些手术由3名操作者完成，每人具有不同程度的高级腹腔镜手术经验。两名不知情的评估者在两个不同时段以5秒间隔独立分析视频。分析重点在于动作类型及其推进任务的效率。
食管裂孔后修补的总时长在165至350秒之间（平均240秒），平均动作数为42次（范围25 - 55次）。总体而言，效率动作（视为“非常高效”和“高效”的动作与视为“一般”或“低效”的动作相比）的平均百分比为44%。经验更丰富的外科医生完成食管裂孔修补所需时间更短，动作效率百分比高于经验不足的外科医生。可以识别出低效或不必要的动作；这些动作在经验更丰富的外科医生中较少见。
视频解构能够对高级腹腔镜手术中的食管裂孔缝合进行批判性分析，突出低效动作。这提供了一种使用现成设备客观评估技术的方法。该方法可用于为外科实习生提供建设性反馈。
