Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
J Endourol. 2012 Mar;26(3):278-82. doi: 10.1089/end.2011.0367. Epub 2012 Jan 4.
Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery--each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons.
Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis.
With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P=0.006). Depth perception showed an improvement close to 35% (P=0.041), and dexterity showed an improvement close to 25% (P=0.011). Total operative time showed trends of improvement, although it was not significant (P=0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P=0.202, P=0.677, and P=0.456, respectively).
These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.
熟练掌握腹腔镜手术依赖于专门技能的获取，而这些技能只能通过特定的培训获得。这种培训可以通过使用无生命模型、动物模型或活体患者手术等多种方式来实现，每种方式都有其优缺点。目前，有大量数据支持动物模型培训在腹腔镜手术初始学习中的益处。然而，这些益处是否延伸到经验较为丰富的外科医生身上尚不确定。本研究旨在确定使用猪模型进行培训是否会使经验丰富的腹腔镜外科医生在腹腔镜技能方面取得可量化的提高。
邀请 6 名具有一定腹腔镜经验的泌尿科医生每周在猪模型上进行根治性肾切除术，共进行 10 周。手术过程被记录下来，并由两位经验丰富的腹腔镜外科医生使用之前发表的手术表现评估工具对手术表现进行评估。然后将获得的数据提交给统计分析。
经过培训，与前 10 次手术的平均值相比，手术中的出血量减少了约 45%（P=0.006）。深度感知能力提高了近 35%（P=0.041），灵巧性提高了近 25%（P=0.011）。尽管总手术时间呈现出改善的趋势，但并不显著（P=0.158）。自主性、效率和组织处理是唯一没有显著变化的方面（P=0.202、P=0.677 和 P=0.456）。
这些发现表明，从动物模型培训中可以获得可量化的腹腔镜技能提高。我们的结果表明，这些益处也延伸到学习曲线的更高级阶段，但尚不清楚在学习曲线的哪个阶段，动物模型培训对腹腔镜手术的表现提供了明显的益处。未来的研究需要证实这些发现，并更好地理解这种学习工具对手术实践的影响。
