Narayanan Sarath Kumar, Cohen Ralph Clinton, Shun Albert
Department of Pediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia,
Pediatr Surg Int. 2014 Jun;30(6):655-61. doi: 10.1007/s00383-014-3502-1. Epub 2014 Apr 20.
Minimal access techniques have transformed the way pediatric surgery is practiced. Due to various constraints, surgical residency programs have not been able to tutor adequate training skills in the routine setting. The advent of new technology and methods in minimally invasive surgery (MIS), has similarly contributed to the need for systematic skills' training in a safe, simulated environment. To enable the training of the proper technique among pediatric surgery trainees, we have advanced a porcine non-survival model for endoscopic surgery.
The technical advancements over the past 3 years and a subjective validation of the porcine model from 114 participating trainees using a standard questionnaire and a 5-point Likert scale have been described here. Mean attitude scores and analysis of variance (ANOVA) were used for statistical analysis of the data.
Almost all trainees agreed or strongly agreed that the animal-based model was appropriate (98.35%) and also acknowledged that such workshops provided adequate practical experience before attempting on human subjects (96.6%). Mean attitude score for respondents was 19.08 (SD 3.4, range 4-20). Attitude scores showed no statistical association with years of experience or the level of seniority, indicating a positive attitude among all groups of respondents.
Structured porcine-based MIS training should be an integral part of skill acquisition for pediatric surgery trainees and the experience gained can be transferred into clinical practice. We advocate that laparoscopic training should begin in a controlled workshop setting before procedures are attempted on human patients.
微创技术改变了小儿外科的手术方式。由于各种限制,外科住院医师培训项目在常规环境中无法传授足够的训练技能。微创手术(MIS)新技术和方法的出现,同样也使得在安全的模拟环境中进行系统技能培训成为必要。为了让小儿外科实习生掌握正确的技术,我们开发了一种用于内镜手术的猪非存活模型。
本文描述了过去3年的技术进步,以及114名参与培训的实习生使用标准问卷和5级李克特量表对猪模型进行的主观验证。使用平均态度得分和方差分析(ANOVA)对数据进行统计分析。
几乎所有实习生都同意或强烈同意基于动物的模型是合适的(98.35%),并且也承认这样的工作坊在尝试对人类受试者进行手术之前提供了足够的实践经验(96.6%)。受访者的平均态度得分为19.08(标准差3.4,范围4 - 20)。态度得分与经验年限或资历水平无统计学关联,表明所有受访者群体都持积极态度。
基于猪模型的结构化MIS培训应成为小儿外科实习生技能获取的一个组成部分,所获得的经验可以转化为临床实践。我们主张在对人类患者进行手术之前,腹腔镜培训应在可控的工作坊环境中开始。