Sharma Mitesh, Macafee David, Pranesh Nagarajan, Horgan Alan F
Newcastle Surgical Training Centre, Department of General Surgery, Freeman Hospital NHS Trust, Newcastle Upon Tyne, NE7 7DN, UK.
JSLS. 2012 Jul-Sep;16(3):345-52. doi: 10.4293/108680812X13462882735818.
The construct validity of fresh human cadaver as a training tool has not been established previously. The aims of this study were to investigate the construct validity of fresh frozen human cadaver as a method of training in minimal access surgery and determine if novices can be rapidly trained using this model to a safe level of performance.
Junior surgical trainees, novices (<3 laparoscopic procedure performed) in laparoscopic surgery, performed 10 repetitions of a set of structured laparoscopic tasks on fresh frozen cadavers. Expert laparoscopists (>100 laparoscopic procedures) performed 3 repetitions of identical tasks. Performances were scored using a validated, objective Global Operative Assessment of Laparoscopic Skills scale. Scores for 3 consecutive repetitions were compared between experts and novices to determine construct validity. Furthermore, to determine if the novices reached a safe level, a trimmed mean of the experts score was used to define a benchmark. Mann-Whitney Utest was used for construct validity analysis and 1-sample t test to compare performances of the novice group with the benchmark safe score.
Ten novices and 2 experts were recruited. Four out of 5 tasks (nondominant to dominant hand transfer; simulated appendicectomy; intracorporeal and extracorporeal knot tying) showed construct validity. Novices' scores became comparable to benchmark scores between the eighth and tenth repetition.
Minimal access surgical training using fresh frozen human cadavers appears to have construct validity. The laparoscopic skills of novices can be accelerated through to a safe level within 8 to 10 repetitions.
新鲜人体尸体作为一种训练工具的结构效度此前尚未得到证实。本研究的目的是调查新鲜冷冻人体尸体作为微创外科手术训练方法的结构效度，并确定新手能否使用该模型快速训练至安全的操作水平。
初级外科实习生，即腹腔镜手术新手（<3次腹腔镜手术操作经验），在新鲜冷冻尸体上对一组结构化的腹腔镜任务进行10次重复操作。专家腹腔镜手术医生（>100次腹腔镜手术操作经验）对相同任务进行3次重复操作。使用经过验证的客观腹腔镜技能全球手术评估量表对操作进行评分。比较专家和新手连续3次重复操作的得分以确定结构效度。此外，为了确定新手是否达到安全水平，使用专家得分的截尾均值来定义一个基准。采用曼-惠特尼U检验进行结构效度分析，采用单样本t检验比较新手组与基准安全得分的操作表现。
招募了10名新手和2名专家。5项任务中的4项（非优势手到优势手的转换；模拟阑尾切除术；体内和体外打结）显示出结构效度。新手的得分在第8次和第10次重复操作之间与基准得分相当。
使用新鲜冷冻人体尸体进行微创外科手术训练似乎具有结构效度。新手的腹腔镜技能可以在8至10次重复操作内加速提升至安全水平。
