Minimally Invasive Surgery Program, Legacy Health System, Portland, OR 97210, USA.
Surg Endosc. 2010 Sep;24(9):2145-55. doi: 10.1007/s00464-010-0913-5. Epub 2010 Feb 21.
This study takes an initial step towards understanding the learning process of flexible endoscopic surgery. Bimanual coordination learning curves were contrasted between three different surgical paradigms. We hypothesized that use of an open or laparoscopic paradigm would result in better performance and a shorter learning process (reaching a learning plateau earlier) than an endoscopic paradigm.
Our model required seven subjects to perform identical bimanual coordination tasks with three different tools (a dual-channel endoscope with graspers, laparoscopic Maryland graspers, and straight hemostats for open surgery). The task required subjects to coordinate two instruments in order to perform a series of standardized maneuvers. Performance was measured by movement speed and accuracy. The learning process was broken down into three distinct phases: the practice phase, the short-term retention phase, and the long-term retention phase. The learning curves of four surgical novices for 33 tasks with each device were compared with the performance of three surgeons.
Overall performance speed was significantly faster using open or laparoscopic tools than endoscopy for all groups (open 13 ± 1 s; lap 28 ± 3 s; endo 202 ± 82 s; P < 0.001). The difference between open and laparoscopy was not significant (P = 0.149). There was no significant difference (P = 0.434) in accuracy (number of ring drops) between any of the devices. Novices performed significantly slower than the expert in the endoscopy task (P = 0.010). Their performance improved with practice (P = 0.005) but they failed to reach the level of the expert after the practice phase (novices: 202.3 ± 23.4 s versus expert: 89.0 ± 34 s, P = 0.009).
Bimanual coordination tasks have shortest performance time and are easiest to learn using an open surgery paradigm. Performance times and the learning process take longer for the laparoscopic paradigm and significantly longer for the endoscopic paradigm.
本研究初步探讨了柔性内镜手术的学习过程。对比了三种不同手术模式的双手协调学习曲线。我们假设，与内镜模式相比，使用开放式或腹腔镜式手术会产生更好的效果和更短的学习过程（更早达到学习平台）。
我们的模型要求 7 名受试者使用三种不同工具（双通道内镜加抓握器、腹腔镜马里兰州抓握器和开放式手术用直止血钳）执行相同的双手协调任务。任务要求受试者协调两个器械以执行一系列标准化操作。表现通过运动速度和准确性来衡量。学习过程分为三个不同阶段：练习阶段、短期保持阶段和长期保持阶段。将四名外科新手在 33 项任务中使用每种设备的学习曲线与三名外科医生的表现进行了比较。
对于所有组，与内镜相比，使用开放式或腹腔镜工具的整体操作速度明显更快（开放式：13 ± 1 s；腹腔镜：28 ± 3 s；内镜：202 ± 82 s；P < 0.001）。开放式和腹腔镜之间的差异无统计学意义（P = 0.149）。任何器械之间的准确性（环滴数）均无显著差异（P = 0.434）。新手在内镜任务中的表现明显慢于专家（P = 0.010）。随着练习，他们的表现有所提高（P = 0.005），但在练习阶段后未能达到专家水平（新手：202.3 ± 23.4 s，专家：89.0 ± 34 s，P = 0.009）。
双手协调任务使用开放式手术模式具有最短的操作时间，并且最容易学习。腹腔镜模式的操作时间和学习过程较长，而内镜模式的操作时间和学习过程则更长。
