Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, 61 Queen Street E., Toronto, Ontario, Canada.
J Endourol. 2012 Apr;26(4):393-7. doi: 10.1089/end.2011.0432. Epub 2012 Jan 4.
Many surgical training programs utilize simulation-based strategies for instruction and assessment of laparoscopic skills. While the use of inanimate, animate, and virtual-reality simulation for basic or procedural skills training has been well described, the use of simulation for the purpose of training surgeons in managing intraoperative laparoscopic complications has been given less attention. We describe a novel, affordable inanimate surgical model for use in simulation-based training of laparoscopic renal hilar vessel injury management.
Using a laparoscopic box trainer, a half-inch Penrose drain, standard silicone intravenous tubing, and a commercially available kidney part-task trainer, an inanimate surgical training model was developed to simulate various clinical scenarios involving renal hilar vessel injuries. To evaluate the construct validity of this training model, urology residents from the University of California, Irvine, completed a simulated scenario involving a renal vein injury (RVI) during laparoscopic radical nephrectomy (LRN).
This surgical model is able to simulate both renal arterial and venous injuries during laparoscopic radical and partial nephrectomy scenarios. Initial cost to construct the model was ~800 U.S. dollars (USD) and each subsequent use was an additional 7 USD. Resident training level correlated strongly with technical performance (p<0.01) and "blood loss" (p=0.02) during the "RVI during LRN" scenario. The checklist and global rating scale used to assess performance demonstrated adequate reliability (Cronbach's α=0.82).
While further validation, technical refinement, and improved fidelity are being considered, we present a novel, affordable surgical model for simulating laparoscopic renal hilar vessel injuries that is suitable for urology trainees.
许多外科培训计划利用基于模拟的策略来指导和评估腹腔镜技能。虽然已经很好地描述了使用无生命、有生命和虚拟现实模拟进行基本或程序技能培训，但使用模拟来培训外科医生处理术中腹腔镜并发症的方法却受到较少关注。我们描述了一种新颖的、经济实惠的无生命外科模型，用于基于模拟的腹腔镜肾门血管损伤管理培训。
使用腹腔镜箱训练器、半英寸的彭罗斯引流管、标准的硅胶静脉管和市售的肾脏部分任务训练器，开发了一种无生命的外科培训模型，以模拟涉及肾门血管损伤的各种临床情况。为了评估这种培训模型的结构有效性，来自加利福尼亚大学欧文分校的泌尿科住院医师完成了涉及腹腔镜根治性肾切除术（LRN）期间肾静脉损伤（RVI）的模拟场景。
这种外科模型能够模拟腹腔镜根治性和部分肾切除术场景中的肾动脉和静脉损伤。构建模型的初始成本约为 800 美元（USD），每次后续使用的成本为 7 美元。住院医师的培训水平与技术表现（p<0.01）和“LRN 期间的 RVI”场景中的“失血量”（p=0.02）密切相关。用于评估表现的检查表和综合评分量表显示出足够的可靠性（Cronbach 的α=0.82）。
虽然正在考虑进一步验证、技术改进和提高保真度，但我们提出了一种新颖的、经济实惠的模拟腹腔镜肾门血管损伤的外科模型，适合泌尿科住院医师使用。
