Department of Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria.
J Vasc Surg. 2013 Apr;57(4):1148-54. doi: 10.1016/j.jvs.2012.08.109. Epub 2013 Jan 9.
Vascular surgeons perform numerous highly sophisticated and delicate procedures. Due to restrictions in training time and the advent of endovascular techniques, new concepts including alternative environments for training and assessment of surgical skills are required. Over the past decade, training on simulators and synthetic models has become more sophisticated and lifelike. This study was designed to evaluate the impact of a 3-day intense training course in open vascular surgery on both specific and global vascular surgical skills.
Prospective observational cohort analysis with various parameter measurements of both surgical skills and the technical quality of the finished product, performed before and after 3 days of simulator training of 10 participants (seven male and three female) in a vascular surgery training course. The simulator model used was a conventional carotid endarterectomy with a Dacron patch plasty on a lifelike carotid bench model under pulsatile pressure. The primary end points were assessment of any changes in the participants' surgical skills and in the technical quality of their completed carotid patches documented by procedure-based assessment forms. Scores ranging from 1 (inadequate) to 5 (excellent) were compared by a related-sample Wilcoxon signed test. Interobserver reliability was estimated by Cronbach's alpha (CA).
A significant improvement in surgical skills tasks was observed (P < .001). The mean score increased significantly by 21.5% from fair (3.43 ± 0.93) to satisfactory (4.17 ± 0.69; P < .001). The mean score for the quality of the carotid patch increased significantly by 0.96 (27%) from fair (3.55 ± 0.87) to satisfactory (4.51 ± 0.76; P < .01). The median interassessor reliability for the quality of the carotid patch was acceptable (CA = 0.713) and for surgical skills was low (CA = 0.424).
This study shows that lifelike simulation featuring pulsatile flow can increase surgical skills and technical quality in a highly sophisticated multistep vascular intervention. This training provides comparatively inexpensive and lifelike training possibilities for the adoption and assessment of surgical skills required to perform delicate vascular surgical procedures.
血管外科医生进行众多复杂精细的手术。由于培训时间的限制和血管内技术的出现，需要新的概念，包括培训和评估手术技能的替代环境。在过去的十年中，模拟训练和合成模型的培训变得更加复杂和逼真。本研究旨在评估为期 3 天的开放式血管外科强化培训课程对特定和整体血管外科技能的影响。
前瞻性观察队列分析，对 10 名（7 名男性和 3 名女性）参与者在血管外科培训课程中进行为期 3 天的模拟训练前后的手术技能和成品技术质量的各项参数进行测量。使用的模拟器模型是传统的颈动脉内膜切除术，在脉动压力下使用逼真的颈动脉工作台模型进行涤纶补丁修补。主要终点是通过基于程序的评估表评估参与者的手术技能和完成的颈动脉斑块的技术质量的任何变化。通过相关样本 Wilcoxon 符号检验比较评分范围为 1（不足）至 5（优秀）的评分。采用 Cronbach's alpha（CA）估计观察者间可靠性。
观察到手术技能任务有显著改善（P<0.001）。平均得分从一般（3.43±0.93）显著提高到满意（4.17±0.69；P<0.001），提高了 21.5%。颈动脉斑块质量的平均评分从一般（3.55±0.87）显著提高到满意（4.51±0.76；P<0.01），提高了 0.96（27%）。颈动脉斑块质量的中位数评估者间可靠性为可接受（CA=0.713），手术技能的可靠性为低（CA=0.424）。
本研究表明，具有脉动流的逼真模拟可以提高复杂的多步骤血管介入手术的手术技能和技术质量。这种培训为采用和评估执行精细血管手术所需的手术技能提供了相对便宜且逼真的培训可能性。
