Shrestha S K, Nomura T, Tajiri T, Akagi I, Aso R, Miyashita M, Yoshimura A, Shimura T
Department of Surgery Kathmandu Medical College Sinamangal, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2009 Jul-Sep;48(175):221-5.
Laparoscopic surgery is unique and complex in nature, so the training is necessary before proceeding to operation room. Many computer aided simulators have been developed for the purpose. Our objective is to assess the improvement of basic laparoscopic skills after training in simulator.
The fifth year medical students underwent training of three laparoscopic skills using Promis2 simulator twice weekly for 4-6 weeks. The skills are laparoscopic orientation, target pointing and objects transferring. Time, path length of instruments and economy of movements were recorded. The comparisons were made for these parameters between session first and the last using a Mann-Whitney U test.
Ten volunteers completed the exercises in less time (186.3 +/- 55.4 seconds) than the first exercise (215.7 +/- 57.4 seconds) (P=0.0027). Both the right and left hand instrument path lengths were also improved from 4425.8 +/- 1284.3 mm in the first exercise to 3925.3 +/- 1313.6 mm in the last exercise in the left side (P=0.0219) and likewise from 4273.8 +/- 1859.4 mm to 3831.3 +/- 1717.4 mm in the right side (P=0.0027). Economy of the movement in the left handed instrument improved from 1114.4 +/- 453.5 mm in the first exercise to 966.8 +/- 411.1 mm in the last (P=0.0443) and in the right handed instrument from 845 +/- 398.8 mm to 771.4 +/- 370.5 mm according to the software of Promis2 simulator (P >0.005).
Training in Promis2 simulator improves the basic laparoscopic skills. The candidates become consistently faster with shorter path lengths and had smoother instruments movements. They also became significantly more consistent in their performance.
腹腔镜手术本质上独特且复杂，因此在进入手术室之前进行培训很有必要。为此已开发了许多计算机辅助模拟器。我们的目的是评估在模拟器中训练后基本腹腔镜技能的提高情况。
五年级医学生使用Promis2模拟器每周两次进行三种腹腔镜技能的训练，共持续4 - 6周。这些技能包括腹腔镜定向、目标指向和物体转移。记录时间、器械的路径长度和动作经济性。使用曼 - 惠特尼U检验对第一次和最后一次训练的这些参数进行比较。
十名志愿者完成练习的时间（186.3±55.4秒）比第一次练习（215.7±57.4秒）短（P = 0.0027）。左手和右手器械的路径长度也都有所改善，左侧从第一次练习的4425.8±1284.3毫米改善到最后一次练习的3925.3±1313.6毫米（P = 0.0219），右侧同样从4273.8±1859.4毫米改善到3831.3±1717.4毫米（P = 0.0027）。根据Promis2模拟器软件，左手器械的动作经济性从第一次练习的1114.4±453.5毫米提高到最后一次的966.8±411.1毫米（P = 0.0443），右手器械从845±398.8毫米提高到771.4±370.5毫米（P>0.005）。
在Promis2模拟器中进行训练可提高基本腹腔镜技能。学员们在操作时持续变得更快，路径长度更短，器械动作更顺畅。他们的操作表现也变得更加稳定。
