Department of Surgery II, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Surg Endosc. 2011 Feb;25(2):423-8. doi: 10.1007/s00464-010-1184-x. Epub 2010 Jun 29.
Laparoscopic surgery requires fundamental skills peculiar to endoscopic procedures such as eye-hand coordination. Acquisition of such skills prior to performing actual surgery is highly desirable for favorable outcome. Virtual-reality simulators have been developed for both surgical training and assessment of performance. The aim of the current study is to show construct validity of a novel simulator, LapVR (Immersion Medical, San Jose, CA, USA), for Japanese surgeons and surgical residents.
Forty-four subjects were divided into the following three groups according to their experience in laparoscopic surgery: 14 residents (RE) with no experience in laparoscopic surgery, 14 junior surgeons (JR) with little experience, and 16 experienced surgeons (EX). All subjects executed "essential task 1" programmed in the LapVR, which consists of six tasks, resulting in automatic measurement of 100 parameters indicating various aspects of laparoscopic skills.
Time required for each task tended to be inversely correlated with experience in laparoscopic surgery. For the peg transfer skill, statistically significant differences were observed between EX and RE in three parameters, including total time and average time taken to complete the procedure and path length for the nondominant hand. For the cutting skill, similar differences were observed between EX and RE in total time, number of unsuccessful cutting attempts, and path length for the nondominant hand. According to the programmed comprehensive evaluation, performance in terms of successful completion of the task and actual experience of the participants in laparoscopic surgery correlated significantly for the peg transfer (P=0.007) and cutting skills (P=0.026).
The peg transfer and cutting skills could best distinguish between EX and RE. This study is the first to provide evidence that LapVR has construct validity to discriminate between novice and experienced laparoscopic surgeons.
腹腔镜手术需要特定于内镜手术的基本技能，例如手眼协调。在进行实际手术之前获得这些技能对于良好的结果是非常理想的。已经开发出虚拟现实模拟器来进行手术培训和绩效评估。本研究的目的是展示一种新型模拟器 LapVR（Immersion Medical，圣何塞，加利福尼亚州，美国）对日本外科医生和外科住院医师的结构有效性。
根据腹腔镜手术经验，将 44 名受试者分为以下三组：14 名无腹腔镜手术经验的住院医师（RE），14 名经验较少的初级外科医生（JR）和 16 名经验丰富的外科医生（EX）。所有受试者均执行了 LapVR 中编程的“基本任务 1”，该任务由六个任务组成，可自动测量 100 个参数，这些参数指示腹腔镜技能的各个方面。
每个任务所需的时间似乎与腹腔镜手术经验呈反比。在针转移技能方面，EX 和 RE 在三个参数上存在统计学差异，包括完成程序的总时间和平均时间以及非主导手的路径长度。在切割技能方面，EX 和 RE 在总时间，不成功切割尝试的次数以及非主导手的路径长度方面也存在相似的差异。根据编程的综合评估，在成功完成任务方面的表现以及参与者在腹腔镜手术方面的实际经验与针转移（P=0.007）和切割技能（P=0.026）之间存在显着相关性。
针转移和切割技能可以最好地区分 EX 和 RE。这项研究首次提供了证据，证明 LapVR 具有构建有效性，可以区分新手和经验丰富的腹腔镜外科医生。
