Dankelman Jenny
Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Mekelweg 2, Delft, 2628, CD, The Netherlands.
World J Surg. 2008 Feb;32(2):149-55. doi: 10.1007/s00268-007-9150-z.
With the introduction of minimally invasive surgery (MIS), it became necessary to develop training methods to learn skills outside the operating room. Several training simulators have become commercially available, but fundamental research into the requirements for effective and efficient training in MIS is still lacking. Three aspects of developing a training program are investigated here: what should be trained, how it should be trained, and how to assess the results of training. In addition, studies are presented that have investigated the role of force feedback in surgical simulators. Training should be adapted to the level of behavior: skill-based, rule-based, or knowledge-based. These levels can be used to design and structure a training program. Extra motivation for training can be created by assessment. During MIS, force feedback is reduced owing to friction in the laparoscopic instruments and within the trocar. The friction characteristics vary largely among instruments and trocars. When force feedback is incorporated into training, it should include the large variation in force feedback properties as well. Training different levels of behavior requires different training methods. Although force feedback is reduced during MIS, it is needed for tissue manipulation, and therefore force application should be trained as well.
随着微创手术（MIS）的引入，开发在手术室之外学习技能的培训方法变得很有必要。几种培训模拟器已在市场上有售，但对于MIS有效且高效培训的要求仍缺乏基础研究。本文研究了制定培训计划的三个方面：应该培训什么、应该如何培训以及如何评估培训结果。此外，还介绍了一些研究，这些研究调查了力反馈在手术模拟器中的作用。培训应适应行为水平：基于技能、基于规则或基于知识。这些水平可用于设计和构建培训计划。评估可以为培训创造额外的动力。在MIS期间，由于腹腔镜器械和套管针内的摩擦，力反馈会降低。不同器械和套管针的摩擦特性差异很大。当将力反馈纳入培训时，也应包括力反馈特性的巨大差异。培训不同水平的行为需要不同的培训方法。虽然在MIS期间力反馈会降低，但组织操作需要力反馈，因此也应培训力的施加。
