Wilasrusmee C, Lertsithichai P, Kittur D S
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
Eur J Vasc Endovasc Surg. 2007 Oct;34(4):405-10. doi: 10.1016/j.ejvs.2007.05.015. Epub 2007 Aug 3.
Previously, we presented a new, laboratory-based, vascular anastomosis model as a tool to objectively quantify surgical skill. The purpose of the present study was to determine the relation between the outcomes of vascular anastomosis in the laboratory and technical competency, when performing similar vascular anastomoses, in the operating room.
Twenty-nine resident surgeons-in-training participated in the present study. All residents had at least one previous laboratory training session using the vascular anastomosis model. Then residents had to create a forearm arterio-venous bridge graft in the operating room (OR). Three measures were used to assess technical competency in the OR: completion time of the graft to vein anatomosis, leakage grade across the anastomosis, and the mini-objective structured assessment of technical skills (MOSAT) score. Similar outcomes obtained in the laboratory were used as predictors of OR outcomes. Significant predictors were identified using multiple linear regression and multiple ordinal logistic regression modelling.
Worse leakage in the laboratory predicted worse leakage in the OR, longer completion time and worse MOSAT score in the OR. Longer completion time in the laboratory was associated with longer OR completion time, but less leakage. Higher year of training and greater laboratory exposure were related to higher MOSAT score and shorter completion time in the OR, respectively.
Completion time and grade of anastomosis leakage measured in the laboratory were predictive of technical competency in the OR. The vascular anastomosis model may be useful for training in clinical surgery.
此前，我们提出了一种基于实验室的新型血管吻合模型，作为客观量化手术技能的工具。本研究的目的是确定在实验室中进行血管吻合的结果与在手术室中进行类似血管吻合时的技术能力之间的关系。
29名住院医师参与了本研究。所有住院医师此前都至少参加过一次使用血管吻合模型的实验室培训课程。然后，住院医师必须在手术室（OR）中创建一个前臂动静脉搭桥移植术。采用三项指标评估手术室中的技术能力：移植至静脉吻合的完成时间、吻合口的渗漏等级以及技术技能的小型客观结构化评估（MOSAT）得分。在实验室中获得的类似结果被用作手术室结果的预测指标。使用多元线性回归和多元有序逻辑回归模型确定显著的预测指标。
实验室中较差的渗漏情况预示着手术室中较差的渗漏情况、较长的完成时间以及较差的MOSAT得分。实验室中较长的完成时间与手术室中较长的完成时间相关，但渗漏较少。培训年份较高和实验室接触较多分别与手术室中较高的MOSAT得分和较短的完成时间相关。
在实验室中测量的完成时间和吻合口渗漏等级可预测手术室中的技术能力。血管吻合模型可能对临床手术培训有用。
