Moldovanu R, Târcoveanu E, Lupaşcu C, Dimofte G, Filip V, Vlad N, Vasilescu A
"Gr.T. Popa" University of Medicine and Pharmacy Iaşi, School of Medicine, Department of Surgery, 1st Surgical Clinic, "St. Spiridon" Clinical Hospital Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2009 Jul-Sep;113(3):780-7.
Laparoscopic simulators provide a safe and efficient means of acquiring surgical skills. It is well known that virtual reality training improves the performance of young surgeons. Most of the virtual reality simulators have construct validity and can differentiate between novice and expert surgeons. However, for some training modules and trainees categories the possibility to distinguish the real surgeon's experience is still discussed.
A total of 14 young surgeons were evaluated during a 5 days postgraduate laparoscopic course using a LapSim Basic Skills, v. 3.0 simulator and a Virtual Laparoscopic Interface (VLI) hardware. The best performances of the surgeons were included in a MS Access database and statistical analyzed.
There were 6 males and 8 women with a mean age of 30.21 +/- 1.01 years old (range 26-38). Nine surgeons (64.28%) were young residents without any laparoscopic surgical experience (group I), and the other 5, had some laparoscopic surgical experience (10 to 30 laparoscopic procedures) (group II). During the instrument navigation task we found that both hands performances were significant better in group II--the navigation time was 12.43 +/- 1.31 vs 19.01 +/- 1.40 seconds for the left hand--p = 0.006 and 13.57 +/- 1.47 vs 22.18 +/- 3.16 seconds for the right hand--p = 0.032); the right instrument angular path degree was also shorter for experienced surgeons (153.17 +/- 16.72 vs 230.88 +/- 22.6 - p = 0.017). The same data were noted for the lifting and grasping module. However, the suturing module tasks revealed contradictory results: the group I residents recorded better performances then the group II surgeons: total time--677.06 +/- 111.48 vs 1122.65 +/- 166.62 seconds; p = 0.043; right instrument path (m)--15.62 +/- 2.47 vs 25.73 +/- 3.13; p = 0.028; right instrument angular path (degree)--3940.43 +/- 572.54 vs 6595.5597 +/- 753.26; p = 0.017.
Laparoscopic simulators are useful to evaluate the surgeons' experience; the parameters of the instrument navigation and lifting and grasping modules, which require a higher degree of eye-hand coordination, were better for residents with previous surgical experience and revealed a good transfer of training (TOT). The suturing module is less influenced by surgeons' experience. This result is probably explained by a lack of TOT.
腹腔镜模拟器提供了一种安全有效的获取手术技能的方法。众所周知，虚拟现实训练可提高年轻外科医生的手术表现。大多数虚拟现实模拟器具有结构效度，能够区分新手和专家外科医生。然而，对于一些训练模块和学员类别，区分真正外科医生经验的可能性仍在讨论中。
在一个为期5天的研究生腹腔镜课程中，使用LapSim基本技能3.0模拟器和虚拟腹腔镜接口（VLI）硬件对14名年轻外科医生进行评估。外科医生的最佳表现被纳入微软Access数据库并进行统计分析。
有6名男性和8名女性，平均年龄为30.21±1.01岁（范围26 - 38岁）。9名外科医生（64.28%）是没有任何腹腔镜手术经验的年轻住院医生（第一组），另外5名有一些腹腔镜手术经验（10至30例腹腔镜手术）（第二组）。在器械导航任务中，我们发现第二组双手的表现明显更好——左手导航时间为12.43±1.31秒，而第一组为19.01±1.40秒——p = 0.006；右手为13.57±1.47秒，而第一组为22.18±3.16秒——p = 0.032）；有经验的外科医生右手器械的角路径度数也更短（153.17±16.72对230.88±22.6——p = 0.017）。在提起和抓握模块中也记录到了相同的数据。然而，缝合模块任务显示出矛盾的结果：第一组住院医生的表现优于第二组外科医生：总时间——677.06±111.48对1122.65±166.62秒；p = 0.043；右手器械路径（米）——15.62±2.47对25.73±3.13；p = 0.028；右手器械角路径（度）——3940.43±572.54对6595.5597±753.26；p = 0.017。
腹腔镜模拟器有助于评估外科医生的经验；器械导航以及提起和抓握模块的参数，这些需要更高程度的眼手协调能力，对于有手术经验的住院医生更好，并且显示出良好的训练迁移（TOT）。缝合模块受外科医生经验的影响较小。这个结果可能是由于缺乏训练迁移来解释的。
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