Department of Biosurgery and Surgical Technology, Imperial College, St Mary's Hospital, Praed St, London W2 1N, UK.
Surg Endosc. 2010 Jun;24(6):1420-6. doi: 10.1007/s00464-009-0792-9. Epub 2010 Jan 1.
Laparoscopic training traditionally follows open surgical training. This study aimed to investigate the impact of experience in open surgery on the laparoscopic proficiency gain process.
A survey form investigating the importance of open experience before the start of laparoscopic training was sent to surgical experts and trainees in the United Kingdom. A separate experimental study objectively assessed the effects of open experience on laparoscopic skill acquisition using a virtual reality simulator. In the study, 11 medical students with no prior surgical experience (group A) and 14 surgical trainees with open but no laparoscopic experience in (group B) performed 250 simulated laparoscopic cholecystectomies. Psychomotor skills were evaluated by motion analysis and video-based global rating scores. Before the first and after the fifth and tenth operation, knowledge of laparoscopic techniques was assessed by a written test and by self-reported confidence levels indicated on a questionnaire.
The 80 experts and 282 trainees who responded to the survey believed prior open experience aids confidence levels, knowledge, and skills acquisition. In the simulation study, no intergroup difference was found for any parameter after the first procedure. Group B scored significantly higher in the laparoscopic knowledge test before training began (42.7% vs. 64.3%; p = 0.002), but no significant difference was found after five operations. The two groups did not differ significantly in terms of confidence. Group B had a significantly shorter total operation time only at the first operation (2,305.6 s vs. 1,884.6 s; p = 0.037). No significant intergroup difference in path length, number of movements, or video-based global rating scores was observed.
Prior open experience does not aid the laparoscopic learning process, as demonstrated in a simulated setting. Given the wealth of evidence demonstrating translation of virtual skills to the operating theater, we propose that the safe and effective introduction of well-supervised laparoscopic training may be possible at the beginning of a surgical training curriculum.
腹腔镜培训传统上遵循开放手术培训。本研究旨在探讨开放手术经验对腹腔镜熟练程度提高过程的影响。
向英国的外科专家和学员发送了一份调查表格，调查他们在开始腹腔镜培训之前开放经验的重要性。一项独立的实验研究使用虚拟现实模拟器客观评估了开放经验对腹腔镜技能获取的影响。在该研究中，11 名没有外科经验的医学生（A 组）和 14 名有开放但没有腹腔镜经验的外科学员（B 组）进行了 250 次模拟腹腔镜胆囊切除术。运动分析和基于视频的综合评分评估了运动技能。在第一次手术前和第五次手术及第十次手术后，通过书面测试和问卷调查评估腹腔镜技术知识和自我报告的信心水平。
对调查做出回应的 80 名专家和 282 名学员认为，之前的开放经验有助于提高信心水平、知识和技能获取。在模拟研究中，第一次手术后，两组之间在任何参数上均无差异。B 组在培训开始前的腹腔镜知识测试中得分明显更高（42.7%对 64.3%；p=0.002），但五次手术后无显著差异。两组在信心方面没有显著差异。B 组仅在第一次手术时的总手术时间明显缩短（2305.6 秒对 1884.6 秒；p=0.037）。在路径长度、动作次数或基于视频的综合评分方面，两组之间没有显著差异。
在模拟环境中，先前的开放经验无助于腹腔镜学习过程。鉴于大量证据表明虚拟技能可以转化为手术室，我们建议在外科培训课程开始时，可能可以安全有效地引入经过良好监督的腹腔镜培训。
