Sabbagh Robert, Chatterjee Suman, Chawla Arun, Kapoor Anil, Matsumoto Edward D
Sherbrooke University, Department of Surgery, Division of Urology, Sherbrooke, Que., and.
Can Urol Assoc J. 2009 Feb;3(1):22-30. doi: 10.5489/cuaj.1011.
Performing a laparoscopic urethrovesical anastomosis (LUA) after a radical prostatectomy is technically challenging for the novice laparoscopic surgeon. We developed a low-fidelity urethrovesical model (UVM) to allow a urologist to practise this critical step. The aim of our study was to compare the effect of task-specific bench model training (anastomotic suturing on the UVM) with that of basic laparoscopic suturing on intracorporeal urethrovesical anastomosis performance.
We recruited 28 senior surgical residents, fellows or staff surgeons for this prospective, single-blinded, randomized controlled study. We randomly assigned participants to an intervention group practising LUA on the UVM or to a control group practising basic laparoscopic suturing and knot-tying on a foam pad. After practising, we videotaped participants performing 5 intra-corporeal interrupted sutures on a foam pad and a LUA on the UVM. A blinded expert scored the videotaped performance using a laparoscopic suturing checklist (CL) and a global rating scale (GRS), and timed the performance.
On the foam pad suturing task, the group that trained on the UVM had significantly higher CL scores (10.9 v. 8.1, p = 0.017). On the LUA task, the group that trained on the UVM had significantly higher CL scores (10.9 v. 8.1, p = 0.017), GRS (29.6 v. 22.8, p = 0.005) and shorter times (27.6 v. 38.3 min, p = 0.004) than the control group.
Our task-specific bench model was shown to be superior to basic laparoscopic suturing drills on a foam pad.
对于新手腹腔镜外科医生而言，在根治性前列腺切除术后进行腹腔镜尿道膀胱吻合术（LUA）在技术上具有挑战性。我们开发了一种低保真度尿道膀胱模型（UVM），以使泌尿外科医生能够练习这一关键步骤。我们研究的目的是比较特定任务的模拟训练模型（在UVM上进行吻合缝合）与基础腹腔镜缝合训练对体内尿道膀胱吻合术操作的影响。
我们招募了28名高级外科住院医师、研究员或外科 staff 医生参与这项前瞻性、单盲、随机对照研究。我们将参与者随机分配到在UVM上练习LUA的干预组，或在泡沫垫上练习基础腹腔镜缝合和打结的对照组。练习后，我们对参与者在泡沫垫上进行5次体内间断缝合以及在UVM上进行LUA的过程进行录像。一名盲法专家使用腹腔镜缝合检查表（CL）和整体评分量表（GRS）对录像表现进行评分，并记录操作时间。
在泡沫垫缝合任务中，在UVM上训练的组CL得分显著更高（10.9对8.1，p = 0.017）。在LUA任务中，与对照组相比，在UVM上训练的组CL得分显著更高（10.9对8.1，p = 0.017）、GRS得分更高（29.6对22.8，p = 0.005）且操作时间更短（27.6对38.3分钟，p = 0.004）。
我们的特定任务模拟训练模型被证明优于在泡沫垫上进行的基础腹腔镜缝合训练。
