Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany.
J Endourol. 2013 Mar;27(3):349-54. doi: 10.1089/end.2012.0209.
Development and full validation of a laparoscopic training program for stepwise learning of a reproducible application of a standardized laparoscopic anastomosis technique and integration into the clinical course.
The training of vesicourethral anastomosis (VUA) was divided into six simple standardized steps. To fix the objective criteria, four experienced surgeons performed the stepwise training protocol. Thirty-eight participants with no previous laparoscopic experience were investigated in their training performance. The times needed to manage each training step and the total training time were recorded. The integration into the clinical course was investigated. The training results and the corresponding steps during laparoscopic radical prostatectomy (LRP) were analyzed. Data analysis of corresponding operating room (OR) sections of 793 LRP was performed. Based on the validity, criteria were determined.
In the laboratory section, a significant reduction of OR time for every step was seen in all participants. Coordination: 62%; longitudinal incision: 52%; inverted U-shape incision: 43%; plexus: 47%. Anastomosis catheter model: 38%. VUA: 38%. The laboratory section required a total time of 29 hours (minimum: 16 hours; maximum: 42 hours). All participants had shorter execution times in the laboratory than under real conditions. The best match was found within the VUA model. To perform an anastomosis under real conditions, 25% more time was needed. By using the training protocol, the performance of the VUA is comparable to that of an surgeon with experience of about 50 laparoscopic VUA. Data analysis proved content, construct, and prognostic validity.
The use of stepwise training approaches enables a surgeon to learn and reproduce complex reconstructive surgical tasks: eg, the VUA in a safe environment. The validity of the designed system is given at all levels and should be used as a standard in the clinical surgical training in laparoscopic reconstructive urology.
开发并全面验证腹腔镜培训计划，以逐步学习可重复应用标准化腹腔镜吻合技术，并将其整合到临床课程中。
将尿道膀胱吻合术（VUA）的培训分为六个简单的标准化步骤。为了固定客观标准，四位有经验的外科医生执行了逐步培训方案。调查了 38 名无先前腹腔镜经验的参与者的培训表现。记录了管理每个培训步骤所需的时间和总培训时间。调查了将其整合到临床课程中的情况。分析了在腹腔镜根治性前列腺切除术（LRP）中培训结果和相应步骤。对 793 例 LRP 的相应手术室（OR）部分进行了数据分析。基于有效性，确定了标准。
在实验室部分，所有参与者的 OR 时间都明显减少。协调：62%；纵向切口：52%；倒 U 形切口：43%；丛：47%。吻合导管模型：38%。VUA：38%。实验室部分共需 29 小时（最短：16 小时；最长：42 小时）。所有参与者在实验室中的执行时间都比实际条件下短。在 VUA 模型中找到了最佳匹配。在实际条件下进行吻合，需要增加 25%的时间。使用培训方案，VUA 的性能可与具有约 50 例腹腔镜 VUA 经验的外科医生相媲美。数据分析证明了内容、结构和预后的有效性。
逐步培训方法可使外科医生在安全的环境中学习和重复复杂的重建性手术任务，例如 VUA。所设计系统的有效性在各个层面上都得到了体现，应作为腹腔镜重建泌尿外科临床培训的标准使用。
