Experimental Surgery Simulation Center, Department of Digestive Surgery, Hospital Clínico, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, Chile.
Surg Endosc. 2012 Dec;26(12):3486-94. doi: 10.1007/s00464-012-2391-4. Epub 2012 Jun 26.
Simulation may provide a solution to acquire advanced laparoscopic skills, thereby completing the curriculum of residency programs in general surgery. This study was designed to present an advanced simulation-training program and to assess the transfer of skills to a live porcine model.
First-year residents were assessed in a 14-session advanced laparoscopic training program followed by performing a jejunojejunostomy in a live porcine model. Previous and after training assessments at the bench model were compared to a single performance of six expert laparoscopic surgeons. Results obtained by trainees at the porcine model assessment were compared to those of 11 general surgeons without any laparoscopic lab-simulation training and 6 expert laparoscopic surgeons. In all assessments, global and specific OSATS scores, operative time, and covered path length of hands were registered.
Twenty-five residents improved significantly their global and specific OSATS score median at the bench model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05 and 7 (range, 4-8) vs. 18 (range, 18-19); p < 0.05, respectively] and obtained significantly better scores on the porcine model compared with general surgeons with no lab-simulation training [21 (range, 20.5-21) vs. 8 (range, 12-14); p < 0.05]. The results were comparable to those achieved by expert certificated bariatric surgeons. Total path lengths registered for trainees were more efficient post-training and significantly lower compared with general surgeons on the porcine model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05] with no statistical difference compared with experts.
Trainees significantly improved their advanced laparoscopic skills to a level compared with expert surgeons. More importantly, these acquired skills were transferred to a more complex live model.
模拟可能为获取高级腹腔镜技能提供解决方案，从而完成普通外科住院医师培训课程。本研究旨在介绍一个高级模拟培训计划，并评估其将技能转移到活体猪模型的能力。
首先，对第一年住院医师进行 14 节高级腹腔镜培训课程，然后在活体猪模型上进行空肠空肠吻合术。在进行活体猪模型评估之前和之后，在基准模型上的评估与六位专家腹腔镜外科医生的单次表现进行了比较。将受训者在猪模型评估中的结果与 11 位从未接受过腹腔镜实验室模拟培训的普通外科医生和 6 位专家腹腔镜外科医生的结果进行了比较。在所有评估中，记录了整体和特定的 OSATS 评分、手术时间和手部覆盖路径长度。
25 名住院医师在基准模型上的整体和特定 OSATS 评分中位数显著提高[7（范围，6-11）比 23（范围，21-24）；p<0.05 和 7（范围，4-8）比 18（范围，18-19）；p<0.05]，并且在猪模型上的得分明显优于未接受实验室模拟培训的普通外科医生[21（范围，20.5-21）比 8（范围，12-14）；p<0.05]。结果与经过认证的减肥外科专家相当。受训者在猪模型上注册的总路径长度在培训后更有效，并且与普通外科医生相比显著降低[7（范围，6-11）比 23（范围，21-24）；p<0.05]，与专家相比无统计学差异。
受训者的高级腹腔镜技能显著提高，达到了与专家相当的水平。更重要的是，这些获得的技能被转移到了更复杂的活体模型中。
