Department of General Surgery, Newcastle Surgical Training Centre, Freeman Hospital NHS Trust, High Heaton, Newcastle upon Tyne, NE12 8WQ, UK.
World J Surg. 2012 Aug;36(8):1732-7. doi: 10.1007/s00268-012-1564-6.
The aim of this study was to compare fresh-frozen cadavers (FFC) with a high-fidelity virtual reality simulator (VRS) as training tools in minimal access surgery for complex and relatively simple procedures.
A prospective comparative face validity study between FFC and VRS (LAP Mentor(™)) was performed. Surgeons were recruited to perform tasks on both FFC and VRS appropriately paired to their experience level. Group A (senior) performed a laparoscopic sigmoid colectomy, Group B (intermediate) performed a laparoscopic incisional hernia repair, and Group C (junior) performed basic laparoscopic tasks (BLT) (camera manipulation, hand-eye coordination, tissue dissection and hand-transferring skills). Each subject completed a 5-point Likert-type questionnaire rating the training modalities in nine domains. Data were analysed using nonparametric tests.
Forty-five surgeons were recruited to participate (15 per skill group). Median scores for subjects in Group A were significantly higher for evaluation of FFC in all nine domains compared to VRS (p < 0.01). Group B scored FFC significantly better (p < 0.05) in all domains except task replication (p = 0.06). Group C scored FFC significantly better (p < 0.01) in eight domains but not on performance feedback (p = 0.09). When compared across groups, juniors accepted VRS as a training model more than did intermediate and senior groups on most domains (p < 0.01) except team work.
Fresh-frozen cadaver is perceived as a significantly overall better model for laparoscopic training than the high-fidelity VRS by all training grades, irrespective of the complexity of the operative procedure performed. VRS is still useful when training junior trainees in BLT.
本研究旨在比较新鲜冷冻尸体（FFC）与高保真虚拟现实模拟器（VRS）作为复杂和相对简单手术微创外科培训工具的效果。
进行了一项前瞻性的 FFC 与 VRS（LAP Mentor(™)）之间的对比有效性研究。招募外科医生在适当匹配其经验水平的情况下在 FFC 和 VRS 上执行任务。A 组（高级）执行腹腔镜乙状结肠切除术，B 组（中级）执行腹腔镜切口疝修补术，C 组（初级）执行基本腹腔镜操作（BLT）（摄像头操作、手眼协调、组织解剖和手转移技能）。每位受试者在九个领域内使用 5 分李克特量表对培训模式进行评分。使用非参数检验分析数据。
共招募了 45 名外科医生参与（每组 15 名）。A 组的中位数评分在所有九个领域中，FFC 的评估均显著高于 VRS（p < 0.01）。B 组在除任务复制（p = 0.06）外的所有领域中，FFC 的评分均显著优于 VRS（p < 0.05）。C 组在除绩效反馈（p = 0.09）外的八个领域中，FFC 的评分均显著优于 VRS（p < 0.01）。当跨组比较时，初级学员在大多数领域（除团队合作外）比中级和高级学员更接受 VRS 作为培训模型（p < 0.01）。
所有培训级别均认为，FFC 作为腹腔镜培训模型，整体上优于高保真 VRS，而与手术操作的复杂程度无关。在 BLT 中培训初级学员时，VRS 仍然是有用的。
