Nehme Jean, Sodergren Mikael Hans, Sugden Colin, Aggarwal Rajesh, Gillen Sonja, Feussner Huburtus, Yang Guang-Zhong, Darzi Ara
1Imperial College, London, UK.
Surg Innov. 2013 Dec;20(6):631-8. doi: 10.1177/1553350613480854. Epub 2013 Mar 13.
The NOSCAR white paper lists training as an important step to the safe clinical application of natural orifice translumenal endoscopic surgery (NOTES). The aim of this randomized controlled trial was to evaluate whether training novices in either a laparoscopic or endoscopic simulator curriculum would affect performance in a NOTES simulator task.
A total of 30 third-year medical undergraduates were recruited. They were randomized to 3 groups: no training (control; n = 10), endoscopy training on a validated colonoscopy simulator protocol (n = 10), and training on a validated laparoscopy simulator curriculum (n = 10). All participants subsequently completed a simulated NOTES task, consisting of 7 steps, on the ELITE (endoscopic-laparoscopic interdisciplinary training entity) model. Performance was assessed as time taken to complete individual steps, overall task time, and number of errors.
The endoscopy group was significantly faster than the control group at accessing the peritoneal cavity through the gastric incision (median 27 vs 78 s; P = .015), applying diathermy to the base of the appendix (median 103.5 vs 173 s; P = .014), and navigating to the gallbladder (median 76 vs 169.5 s; P = .049). Endoscopy participants completed the full NOTES procedure in a shorter time than the laparoscopy group (median 863 vs 2074 s; P < .001).
This study highlights the importance of endoscopic training for a simulated NOTES task that involves both navigation and resection with operative maneuvers. Although laparoscopic training confers some benefit for operative steps such as applying diathermy to the gallbladder fossa, this was not as beneficial as training in endoscopy.
NOSCAR白皮书将培训列为自然腔道内镜手术（NOTES）安全临床应用的重要一步。本随机对照试验的目的是评估对新手进行腹腔镜或内镜模拟器课程培训是否会影响NOTES模拟器任务的表现。
共招募了30名三年级医学本科生。他们被随机分为3组：无培训（对照组；n = 10）、按照经过验证的结肠镜检查模拟器方案进行内镜培训（n = 10）、按照经过验证的腹腔镜模拟器课程进行培训（n = 10）。随后，所有参与者在ELITE（内镜-腹腔镜跨学科训练实体）模型上完成了一项由7个步骤组成的模拟NOTES任务。通过完成各个步骤所需的时间、总体任务时间和错误数量来评估表现。
在内镜组通过胃切口进入腹腔（中位数27秒对78秒；P = 0.015）、对阑尾根部进行电凝（中位数103.5秒对173秒；P = 0.014）以及导航至胆囊（中位数76秒对169.5秒；P = 0.049）方面，显著快于对照组。内镜组参与者完成整个NOTES手术的时间比腹腔镜组短（中位数863秒对2074秒；P < 0.001）。
本研究强调了内镜培训对于涉及导航和手术操作切除的模拟NOTES任务的重要性。尽管腹腔镜培训在诸如对胆囊窝进行电凝等手术步骤方面有一定益处，但不如内镜培训有益。
