Varley Martin, Choi Ryan, Kuan Kean, Bhardwaj Neil, Trochsler Markus, Maddern Guy, Hewett Peter, Mees Soeren Torge
Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, 5011, Australia.
Surg Endosc. 2015 Jan;29(1):113-8. doi: 10.1007/s00464-014-3647-y. Epub 2014 Jul 9.
Skills in single-incision laparoscopic surgery (SILS) are difficult to acquire. Simulation training leads to skill acquisition but circumstances about skill deterioration are unclear. The aim of this study was to evaluate skill acquisition and retention after single-incision laparoscopic simulation training.
From October 2013 to January 2014, 30 surgically naive participants underwent a SILS training curriculum and completed two validated tasks (peg transfer, precision cutting) with subsequent testing to assess acquisition of skills (baseline testing, BT). The participants were randomized into two groups and skill retention testing (RT) was measured after 4 weeks (group A) or 12 weeks (group B). Task completion was measured in time with penalties for inaccurate performance.
A SILS training curriculum was established. 90 % of the participants completed the training successfully and reached the required levels of proficiency. Comparison of BT and RT revealed significantly better RT performances for peg transfer and precision cutting in group A (P < 0.05). These effects were not seen for RT in group B. Evaluating the RT performance of both groups, group A showed a non-significant trend for improved peg transfer and precision cutting compared to group B.
A proficiency-based training curriculum for acquisition of basic SILS skills was successfully established in our department. The results of this study indicate that acquired SILS skills are well retained for a short period without training (4 weeks) but a longer non-training period (12 weeks) resulted in a significant loss of acquired skills. For enhancement of surgical skills, specialised SILS training curricula could be developed for novices and inexperienced surgeons; however, continuous training is essential to maintain these acquired skills.
单孔腹腔镜手术（SILS）技能难以掌握。模拟训练有助于技能的获得，但技能退化的情况尚不清楚。本研究的目的是评估单孔腹腔镜模拟训练后技能的获得与保持情况。
2013年10月至2014年1月，30名未接受过外科手术的参与者接受了SILS培训课程，并完成了两项经过验证的任务（移钉、精确切割），随后进行测试以评估技能的获得情况（基线测试，BT）。参与者被随机分为两组，分别在4周（A组）或12周（B组）后进行技能保持测试（RT）。通过记录任务完成时间并对不准确的操作进行处罚来衡量任务完成情况。
建立了SILS培训课程。90%的参与者成功完成培训并达到了所需的熟练程度。比较BT和RT发现，A组在移钉和精确切割方面的RT表现明显更好（P<0.05）。B组的RT未观察到这些效果。评估两组的RT表现，A组与B组相比，在移钉和精确切割方面有改善的非显著趋势。
我们科室成功建立了基于熟练程度的基本SILS技能培训课程。本研究结果表明，获得的SILS技能在未经训练的短时间内（4周）能很好地保持，但较长时间的无训练期（12周）会导致获得的技能显著丧失。为提高手术技能，可为新手和经验不足的外科医生制定专门的SILS培训课程；然而，持续训练对于保持这些获得的技能至关重要。
