Hassan Iyad, Osei-Agymang Thomas, Radu Daniela, Gerdes Berthold, Rothmund Matthias, Fernández Emilio Domínguez
Klinik für Visceral-, Thorax- und Gefässchirurgie, Philipps-Universität Marburg, Germany.
Wien Klin Wochenschr. 2008;120(3-4):70-6. doi: 10.1007/s00508-008-0930-8.
It is well known that learning curves are longer for laparoscopic surgery compared to open surgery. Recently, virtual reality (VR) simulation was developed as alternative to conventional training. Such a new training system makes it possible to offer a wide range of repeatable surgical situations, and thus, enable assessments based on direct observation of performance. During the last four years we did several studies using a VR simulator (LapSim). After a constructive validity study - discrimination between novices and experienced laparoscopic surgeons, we were able to show that advanced residents benefit most from a three-day practical course for laparoscopic surgery, while - in a further investigation - we found contrary to training at the Pelvitrainer that novices in laparoscopic surgery have the most benefit from VR training. Minimally invasive surgery is significantly more sophisticated for the surgeon than open surgery. While Research on laparoscopic surgery has focused primarily on the development and assessment of technical skills, non technical skills such as visual-spatial perception and stress coping has received much less attention. We showed that spatial perception as well as stress coping positively correlates with virtual laparoscopic skills. A high degree of spatial perception led to faster adaption to a non-stereo environment and correlated with high level of laparoscopic skills. Furthermore, Ineffective stress-coping strategies correlate with poor virtual laparoscopic performance. VR simulation seems to be a promising tool to improve laparoscopic skills in a modern apprenticeship model. According to patient safety, the development of this instrument for surgery should be advanced professionally just as a flight simulators in aviation.
众所周知，与开放手术相比，腹腔镜手术的学习曲线更长。最近，虚拟现实（VR）模拟技术被开发出来作为传统培训的替代方法。这种新的培训系统能够提供广泛的可重复手术场景，从而实现基于对操作表现的直接观察进行评估。在过去四年里，我们使用VR模拟器（LapSim）进行了多项研究。在一项关于新手和经验丰富的腹腔镜外科医生之间区分的结构效度研究之后，我们发现高级住院医师从为期三天的腹腔镜手术实践课程中获益最大，而在进一步的调查中，我们发现与在Pelvitrainer上的训练相反，腹腔镜手术新手从VR训练中获益最多。微创手术对外科医生来说比开放手术复杂得多。虽然对腹腔镜手术的研究主要集中在技术技能的发展和评估上，但诸如视觉空间感知和压力应对等非技术技能受到的关注要少得多。我们发现空间感知以及压力应对与虚拟腹腔镜技能呈正相关。高度的空间感知能更快适应非立体环境，并与高水平的腹腔镜技能相关。此外，无效的压力应对策略与较差的虚拟腹腔镜表现相关。VR模拟似乎是一种在现代学徒模式中提高腹腔镜技能的有前途的工具。从患者安全角度来看，这种手术器械的开发应该像航空领域的飞行模拟器一样专业推进。
