Maschuw K, Hassan I, Bartsch D K
Klinik für Visceral-, Thorax- und Gefässchirurgie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Philipps-Universität, Marburg, Deutschland.
Chirurg. 2010 Jan;81(1):19-24. doi: 10.1007/s00104-009-1757-1.
Learning of laparoscopic operative skills is often complex and time consuming resulting in a learning curve especially for novices in surgery. Virtual reality (VR) simulation was developed as an alternative to conventional training, such as active assistance and conventional laparoscopic training with artificially perfused organs (Pop-Trainer). VR simulation enables a wide range of repeatable laparoscopic techniques in variable virtual scenarios. For abdominal surgery four different simulation systems (MIST-VR(R), LapSim, Simsurgery, Lap-Mentor) are currently available and the modules allow simulation of abstract exercises to more advanced laparoscopic procedures, such as laparoscopic sigmoid resection. The effect of VR training on laparoscopic performance and its impact on non-technical skills was evaluated using the simulator LapSim after a constructive validity study. Novices benefited most from VR training and performance in the operating room improved significantly after VR training. Good spatial perception and positive stress coping strategies also enhanced laparoscopic performance. VR simulation provides a tool to shift the laparoscopic learning curve outside the operating room and thus contributes to patient safety. It would be worthwhile to include VR training in the surgical curriculum. For economic reasons regional training centers seem to be an effective way to realize a broad implementation of VR simulation in surgical training. Application and development of VR simulators should be professionally promoted just as flight simulators in aviation.
学习腹腔镜手术技能通常复杂且耗时，尤其是对于外科新手而言会形成一条学习曲线。虚拟现实（VR）模拟技术作为传统培训方式的替代方法而得以发展，传统培训方式包括主动辅助以及使用人工灌注器官的传统腹腔镜培训（Pop-Trainer）。VR模拟能够在各种虚拟场景中实现多种可重复的腹腔镜技术。目前有四种不同的模拟系统（MIST-VR(R)、LapSim、Simsurgery、Lap-Mentor）可用于腹部手术，其模块可模拟从抽象练习到更高级的腹腔镜手术，如腹腔镜乙状结肠切除术。在进行了一项结构效度研究后，使用LapSim模拟器评估了VR培训对腹腔镜操作表现的影响及其对非技术技能的作用。新手从VR培训中获益最多，VR培训后手术室中的操作表现有显著改善。良好的空间感知和积极的压力应对策略也提升了腹腔镜操作表现。VR模拟提供了一种将腹腔镜学习曲线转移到手术室之外的工具，从而有助于患者安全。将VR培训纳入外科课程是值得的。出于经济原因，区域培训中心似乎是在外科培训中广泛实施VR模拟的有效途径。应像航空领域推广飞行模拟器一样专业地推动VR模拟器的应用和开发。
