Van Bruwaene Siska, Schijven Marlies P, Miserez Marc
Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals, Leuven, Belgium.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
J Surg Educ. 2014 Sep-Oct;71(5):654-61. doi: 10.1016/j.jsurg.2014.01.005. Epub 2014 Apr 14.
The LAP Mentor is a procedural simulator that provides a stepwise training for laparoscopic cholecystectomy. This study addresses its "construct" validity that is present when a simulator is able to discriminate between persons with known differences in performance level on the laparoscopic cholecystectomy in real life.
Three groups with different skill levels performed 2 trials of 4 distinct parts of the cholecystectomy procedure (cholecystectomy exercises) and 1 full procedure on the LAP Mentor. Assessment parameters concerning the quantity and the quality of performance were compared between groups using the Kruskal-Wallis and Mann-Whitney U tests.
The entire research was performed in the Center for Surgical Technologies, Leuven, Belgium.
For study purposes, 5 expert abdominal laparoscopists (>100 laparoscopic cholecystectomies performed), 11 surgical residents (10-30 cholecystectomies performed), and 10 novices (minimal laparoscopic experience) were recruited.
With regard to the quantity of performance (time needed and number of movements), the experts showed significantly better results compared with the novices in the cholecystectomy exercises. Only in the full procedure, the results of all the parameters (except speed) were significantly different between the 3 groups, with the best results observed for the experts and worst for the novices. With respect to quality of performance, only the parameter "accuracy rate of dissection" in exercise 3 showed significantly better performance by the experts.
Only the full procedure of the LAP Mentor procedural simulator has enough discriminative power to claim construct validity. However, the lack of quality control, which is indispensible in the evaluation of procedural skills, makes it currently unsuited for the assessment of procedural laparoscopic skills. The role of the simulator in a training context remains to be elucidated.
LAP Mentor是一种程序模拟器，可提供腹腔镜胆囊切除术的逐步培训。本研究探讨其“结构”效度，即当模拟器能够区分在现实生活中腹腔镜胆囊切除术表现水平存在已知差异的人员时所具备的效度。
三组技能水平不同的人员在LAP Mentor上对胆囊切除术的4个不同部分（胆囊切除术练习）进行了2次试验，并进行了1次完整手术。使用Kruskal-Wallis和Mann-Whitney U检验比较了各组之间关于操作数量和质量的评估参数。
整个研究在比利时鲁汶的外科技术中心进行。
为进行研究，招募了5名腹部腹腔镜专家（已进行超过100例腹腔镜胆囊切除术）、11名外科住院医师（已进行10 - 30例胆囊切除术）和10名新手（腹腔镜经验极少）。
在胆囊切除术练习中，就操作数量（所需时间和动作次数）而言，专家组的结果明显优于新手组。仅在完整手术中，三组之间所有参数（速度除外）的结果存在显著差异，专家组结果最佳，新手组最差。在操作质量方面，仅练习3中的“解剖准确率”参数显示专家组表现明显更好。
只有LAP Mentor程序模拟器的完整手术部分具有足够的区分能力来宣称具有结构效度。然而，缺乏在程序技能评估中必不可少的质量控制，使得它目前不适合用于评估腹腔镜程序技能。模拟器在培训环境中的作用仍有待阐明。
