Frigenza M, Tran A, Breaud J, Fournier J-P, Bongain A, Delotte J
Service de gynécologie-obstétrique-reproduction et de médecine fœtale du CHU de Nice, centre hospitalo-universitaire de l'Archet 2, université de Nice-Sophia-Antipolis, 151, route Saint-Antoine-de-Ginestière, 06200 Nice, France.
Service de pédiatrie, université de Nice-Sophia-Antipolis, GCS CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France.
J Visc Surg. 2014 Oct;151(5):335-9. doi: 10.1016/j.jviscsurg.2014.08.004. Epub 2014 Sep 8.
Evaluate the learning curve of SILS (Single Incision Laparoscopic Surgery) on a simulator, based on two tests of the Fundamentals of Laparoscopic Surgery certification program (FLS(®)), in a population of novice medical students, and compare their performance to those of senior surgeons practicing both "conventional" laparoscopic surgery and SILS.
Monocentric prospective study with four groups: two groups of novice medical students, and two groups of senior surgeons. The two FLS(®) tests used for evaluation were the peg transfer and the precision cutting tasks.
No statistically significant differences were found between the novice groups, whether they started their first session directly, or immediately after watching a video presentation of the exercises. For the novice medical students, the average completion time of both tests improved significantly between the first and the sixth sessions with a short learning curve. The group of experienced seniors performed fastest in both tests. For the peg transfer task, the skills of the novice medical students were comparable to those of non-experienced seniors after the 4th session and improved after 6 sessions (P=0.017). For the precision cutting task, the average timing of the novice group became better than that of the non-experienced seniors, starting from the third session.
FLS(®) "low fidelity" simulator training is effective for the training of novice medical students. To minimize the risk of technical errors, novice medical students should practice a minimum of six simulator-training sessions before starting their practical learning of SILS in the operating room.
在新手医学生群体中，基于腹腔镜手术基础认证项目（FLS(®)）的两项测试，评估单孔腹腔镜手术（SILS）在模拟器上的学习曲线，并将他们的表现与实施“传统”腹腔镜手术和SILS的资深外科医生进行比较。
单中心前瞻性研究，分为四组：两组新手医学生和两组资深外科医生。用于评估的两项FLS(®)测试为移钉和精确切割任务。
新手组之间未发现统计学上的显著差异，无论他们是直接开始第一阶段，还是在观看练习视频演示后立即开始。对于新手医学生，两项测试的平均完成时间在第一阶段和第六阶段之间有显著改善，学习曲线较短。经验丰富的资深医生组在两项测试中表现最快。在移钉任务中，新手医学生在第4阶段后的技能与无经验的资深医生相当，并在6阶段后有所提高（P = 0.017）。在精确切割任务中，新手组的平均用时从第三阶段开始就优于无经验的资深医生组。
FLS(®)“低保真度”模拟器训练对新手医学生的培训有效。为了将技术错误风险降至最低，新手医学生在开始在手术室实际学习SILS之前，应至少进行六次模拟器训练课程。
