Romero P, Brands O, Nickel F, Müller B, Günther P, Holland-Cunz S
Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
J Pediatr Surg. 2014 Jul;49(7):1138-41. doi: 10.1016/j.jpedsurg.2013.12.018. Epub 2013 Dec 30.
Intracorporeal suturing and knot tying (ICKT) in minimal invasive surgery (MIS) represents a key skill for advanced procedures. Different methods exist for measuring knot quality and performance, but the heterogeneity of these methods makes direct comparisons difficult. The aim of this study is to compare the quality of a laparoscopic knot to one that is performed open.
To compare open and laparoscopic knot-tying methods we used a surgeon's square knot. For laparoscopic knot tying we used a Pelvitrainer. The 32 participants were divided among 4 groups of different skill levels. Group 1 consisted of 6 senior physicians. Group 2 was made up of 10 first to fourth year interns. Groups 3 and 4 contained 16 medical students who had never performed either laparoscopic procedures or open sutures before. Group 3 participants received a 1-hour hands-on training in suturing, whereas group 4 participants received no prior training. Total time, knot quality, suture placement accuracy, and performance defined the parameters for assessment in this study.
All participants, irrespective of education level were inferior in ICKT compared to open suturing. Only Group 1 showed no significant difference in knot quality and accuracy between the open and laparoscopic suture performance.
It is well documented that psychomotor skills need to be developed before more advanced skills can be put into practice. Training centres for minimally invasive surgery should be an integral part of surgical education. The variables in our study are meaningful and easy to implement. They can be used to measure personal progress and as objective parameters in the development of laparoscopic trainee education.
微创手术（MIS）中的体内缝合和打结（ICKT）是高级手术的一项关键技能。存在多种测量结质量和性能的方法，但这些方法的异质性使得直接比较变得困难。本研究的目的是比较腹腔镜打结与开放打结的质量。
为了比较开放和腹腔镜打结方法，我们使用了外科医生的方结。对于腹腔镜打结，我们使用了骨盆训练器。32名参与者被分为4组不同技能水平的小组。第1组由6名资深医生组成。第2组由10名一年级至四年级实习生组成。第3组和第4组包含16名之前从未进行过腹腔镜手术或开放缝合的医学生。第3组参与者接受了1小时的缝合实践培训，而第4组参与者未接受过先前培训。总时间、结质量、缝线放置准确性和操作表现定义了本研究中的评估参数。
与开放缝合相比，所有参与者，无论教育水平如何，在ICKT方面都较差。只有第1组在开放和腹腔镜缝合操作的结质量和准确性方面没有显著差异。
有充分记录表明，在能够实践更高级技能之前，需要先培养心理运动技能。微创手术培训中心应成为外科教育的一个组成部分。我们研究中的变量有意义且易于实施。它们可用于衡量个人进展，并作为腹腔镜实习医生教育发展中的客观参数。
