Department of Biosurgery and Surgical Technology, Imperial College, St. Mary's Hospital, 10th Floor QEQM Building, London, UK.
Surg Endosc. 2010 Jan;24(1):179-87. doi: 10.1007/s00464-009-0624-y. Epub 2009 Jul 25.
Concerns for patient safety have accelerated the need for alternative training strategies outside the operating room. Mental practice (MP: the use of mental imagery to rehearse a task symbolically before performance) has been used successfully in sports and music to enhance skill. This study aimed to develop and validate a MP training strategy for laparoscopic surgery.
A cognitive "walk through" was conducted for a laparoscopic cholecystectomy (LC) to identify key visual, cognitive, and kinesthetic cues for the procedure. This was used to develop a MP training protocol featuring an "MP script" to enhance mental imagery of a LC. The script was validated by asking each subject to rehearse mentally a LC within 30 min. Ability to practice this procedure mentally was assessed before and after MP training with a modified version of a validated questionnaire (minimum score, 8; maximum score, 56).
The study was completed by 20 subjects (10 experienced surgeons >100 LCs, 10 novice surgeons <10 LCs). Reliability testing of the questionnaire gave it a Cronbach alpha of 0.984 (n = 20) before MP training and 0.879 (n = 20) after MP training, indicating internal consistency. The construct validity of the questionnaire is supported by the fact that the experienced surgeons scored higher on all the questions than the novices both before and after training. Significant improvement in global imagery score after MP was shown by both experienced (48 before MP vs. 53 after MP; p = 0.007) and novice (15 before MP vs. 42 after MP; p = 0.005) surgeons, suggesting both face and content validity.
This is the first study to develop and validate MP as a novel training approach for laparoscopic surgery. Mental practice may be a time- and cost-effective strategy that improves surgeons' ability to visualize themselves performing a LC, increasing both their knowledge and confidence.
对患者安全的关注加速了对手术室以外替代培训策略的需求。心理练习（MP：在执行任务之前通过心理意象象征性地进行练习）已成功用于运动和音乐领域，以提高技能。本研究旨在开发和验证腹腔镜手术的 MP 培训策略。
对腹腔镜胆囊切除术（LC）进行认知“演练”，以确定该手术的关键视觉、认知和动觉线索。这用于开发一个 MP 培训方案，该方案具有一个“MP 脚本”，以增强对 LC 的心理意象。通过要求每位受试者在 30 分钟内进行心理演练来验证脚本。在 MP 训练前后，使用经过验证的问卷的修改版本评估进行心理演练的能力（最低分数为 8，最高分数为 56）。
共有 20 名受试者（10 名经验丰富的外科医生> 100 例 LC，10 名新手外科医生< 10 例 LC）完成了该研究。在 MP 训练前，问卷的可靠性测试得分为 0.984（n = 20），MP 训练后为 0.879（n = 20），表明内部一致性。问卷的结构有效性得到了支持，即经验丰富的外科医生在培训前后的所有问题上的得分均高于新手。经验丰富的外科医生（MP 前 48 分，MP 后 53 分；p = 0.007）和新手（MP 前 15 分，MP 后 42 分；p = 0.005）的整体图像评分在 MP 后均有显著提高，这表明具有良好的表面效度和内容效度。
这是第一项开发和验证 MP 作为腹腔镜手术新培训方法的研究。心理练习可能是一种提高外科医生想象自己执行 LC 能力的省时、经济有效的策略，从而提高他们的知识和信心。
