Newcastle Surgical Training Centre, Department of General Surgery, Freeman Hospital NHS Trust, Newcastle Upon Tyne NE7 7DN, UK.
Am J Surg. 2013 Jul;206(1):23-31. doi: 10.1016/j.amjsurg.2012.10.037. Epub 2013 Apr 25.
The purpose of this study was to determine whether training on fresh cadavers improves the laparoscopic skills performance of novices.
Junior surgical trainees, novices (<3 laparoscopic procedure performed) in laparoscopic surgery, were randomized into control (group A) and practice groups (group B). Group B performed 10 repetitions of a set of structured laparoscopic tasks on fresh frozen cadavers (FFCs) improvised from fundamentals of laparoscopic skills technical curriculum. Performance on cadavers was scored using a validated, objective Global Operative Assessment of Laparoscopic Skills scale. The baseline technical ability of the 2 groups and any transfer of skills from FFCs was measured using a full procedural laparoscopic cholecystectomy task on a virtual reality simulator before and after practice on FFCs, respectively. Nonparametric tests were used for analysis of the results.
Twenty candidates were randomized; 1 withdrew before the study commenced, and 19 were analyzed (group A, n = 9; group B; n = 10). Four of 5 tasks (nondominant to dominant hand transfer, simulated appendectomy, intracorporeal, and extracorporeal knot tying) on FFCs showed significant improvement on learning curve analysis. After training, significant improvement was shown for safety of cautery (P = .040) and the left arm path length (P = .047) on the virtual reality simulator by the practice group.
Training on FFCs significantly improves basic laparoscopic skills and can improve full procedural performance.
本研究旨在确定在新鲜尸体上进行培训是否能提高新手的腹腔镜技能表现。
初级外科受训者，腹腔镜手术新手（<3 次腹腔镜手术），随机分为对照组（A 组）和实践组（B 组）。B 组在新鲜冷冻尸体（FFC）上进行了 10 次结构化腹腔镜任务的重复操作，这些尸体是由腹腔镜技能技术课程的基本原理即兴制作的。使用经过验证的客观腹腔镜技能全球操作评估量表对尸体进行评分。在使用 FFC 进行练习之前和之后，分别使用完整的腹腔镜胆囊切除术任务在虚拟现实模拟器上测量两组的基线技术能力和从 FFC 转移的任何技能。使用非参数检验进行结果分析。
20 名候选人被随机分配；1 名在研究开始前退出，19 名被分析（A 组，n=9；B 组，n=10）。FFC 上的 5 项任务中的 4 项（非优势手到优势手的转移、模拟阑尾切除术、体腔和体腔外打结）在学习曲线上显示出显著的改善。经过培训，实践组在虚拟现实模拟器上的安全性（P=.040）和左手臂路径长度（P=.047）方面显示出显著改善。
在 FFC 上进行培训可显著提高基本腹腔镜技能，并可提高完整手术的表现。
