Lucas Steven M, Zeltser Ilia S, Bensalah Karim, Tuncel Altug, Jenkins Adam, Pearle Margaret S, Cadeddu Jeffrey A
University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
J Urol. 2008 Dec;180(6):2588-91; discussion 2591. doi: 10.1016/j.juro.2008.08.041. Epub 2008 Oct 31.
Virtual reality simulators provide a safe and efficient means of acquiring laparoscopic skills. We evaluated whether training on a virtual reality laparoscopic cholecystectomy simulator (Lap Mentor) improves the performance of a live, unrelated laparoscopic urological procedure.
A total of 32 medical students with no previous laparoscopic experience were oriented to the Lap Mentor, and then performed virtual reality laparoscopic cholecystectomy which was assessed by 2 experienced laparoscopists using the previously validated Objective Structured Assessment of Technical Skills scoring. Subjects were randomized to group 1, in which participants completed 6, 30-minute virtual reality training sessions within 3 weeks, or group 2, in which participants received no training. All participants then performed live laparoscopic nephrectomy in a porcine model and performance was evaluated using Objective Structured Assessment of Technical Skills by 2 experts blinded to training status.
Mean total pretraining laparoscopic cholecystectomy Objective Structured Assessment of Technical Skills scores were comparable between the groups (16.9 +/- 4.3 for group 1 vs 15.4 +/- 6.2 for group 2, p = 0.4). After training total Objective Structured Assessment of Technical Skills scores for live porcine laparoscopic nephrectomy were significantly higher in group 1 compared to group 2 (21.0 +/- 6.8 vs 15.7 +/- 6.6, respectively, p = 0.03). Likewise, individual subcategory Objective Structured Assessment of Technical Skills scores were higher in group 1 than in group 2, although significant differences were noted only in the categories of instrument handling and knowledge of the procedure.
Surgical skills acquired as a result of training on a virtual reality laparoscopic simulator are not procedure specific but improve overall surgical skills, thereby translating into superior performance of an unrelated live laparoscopic urological procedure.
虚拟现实模拟器为获取腹腔镜手术技能提供了一种安全有效的方法。我们评估了在虚拟现实腹腔镜胆囊切除术模拟器（Lap Mentor）上进行训练是否能提高非相关的真实腹腔镜泌尿外科手术的操作表现。
共有32名此前无腹腔镜手术经验的医学生熟悉了Lap Mentor，然后进行虚拟现实腹腔镜胆囊切除术，由2名经验丰富的腹腔镜手术医生使用先前验证过的客观结构化技术技能评估进行评分。受试者被随机分为1组，参与者在3周内完成6次、每次30分钟的虚拟现实训练课程；或2组，参与者不接受训练。所有参与者随后在猪模型上进行真实腹腔镜肾切除术，并由2名对训练状态不知情的专家使用客观结构化技术技能评估来评估操作表现。
两组术前腹腔镜胆囊切除术客观结构化技术技能评估的平均总分相当（1组为16.9±4.3，2组为15.4±6.2，p = 0.4）。训练后，1组在猪模型上进行真实腹腔镜肾切除术的客观结构化技术技能评估总分显著高于2组（分别为21.0±6.8和15.7±6.6，p = 0.03）。同样，1组的各个子类别客观结构化技术技能评估得分高于2组，尽管仅在器械操作和手术知识类别中发现显著差异。
通过在虚拟现实腹腔镜模拟器上训练获得的手术技能并非特定于某一手术，而是能提高整体手术技能，从而在非相关的真实腹腔镜泌尿外科手术中表现更优。
