Van Bruwaene Siska, Schijven Marlies P, Napolitano Daniel, De Win Gunter, Miserez Marc
Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
J Surg Educ. 2015 May-Jun;72(3):483-90. doi: 10.1016/j.jsurg.2014.11.015. Epub 2014 Dec 30.
As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live animal model in a prospective randomized trial.
After completing an intensive training in basic laparoscopic skills, 3 groups of 10 participants proceeded with no additional training (control group), 5 hours of cholecystectomy training on cadaver organs (= organ training) or proficiency-based cholecystectomy training on the LapMentor (= virtual-reality training). Participants were evaluated on time and quality during a laparoscopic cholecystectomy on a live anaesthetized pig at baseline, 1 week (= post) and 4 months (= retention) after training.
All research was performed in the Center for Surgical Technologies, Leuven, Belgium.
In total, 30 volunteering medical students without prior experience in laparoscopy or minimally invasive surgery from the University of Leuven (Belgium).
The organ training group performed the procedure significantly faster than the virtual trainer and borderline significantly faster than control group at posttesting. Only 1 of 3 expert raters suggested significantly better quality of performance of the organ training group compared with both the other groups at posttesting (p < 0.01). There were no significant differences between groups at retention testing. The virtual trainer group did not outperform the control group at any time.
For trainees who are proficient in basic laparoscopic skills, the long-term advantage of additional procedural training, especially on a virtual but also on the conventional organ training model, remains to be proven.
由于传统的腹腔镜手术操作培训需要活体动物或尸体器官，虚拟模拟似乎是一种有吸引力的替代方法。因此，我们在一项前瞻性随机试验中，比较了在猪尸体器官上进行腹腔镜胆囊切除术培训与虚拟模拟培训向活体动物模型手术的训练迁移情况。
在完成基础腹腔镜技能强化培训后，3组每组10名参与者分别进行无额外培训（对照组）、在尸体器官上进行5小时胆囊切除术培训（=器官培训）或在LapMentor上进行基于熟练度的胆囊切除术培训（=虚拟现实培训）。在基线、训练后1周（=术后）和4个月（=保留期）对活体麻醉猪进行腹腔镜胆囊切除术时，对参与者的时间和质量进行评估。
所有研究均在比利时鲁汶的外科技术中心进行。
共有30名来自比利时鲁汶大学的志愿医学生，他们此前没有腹腔镜或微创手术经验。
在术后测试中，器官培训组完成手术的速度明显快于虚拟培训组，且略快于对照组。在术后测试中，3名专家评分者中只有1人认为器官培训组的手术质量明显优于其他两组（p<0.01）。在保留期测试中，各组之间没有显著差异。虚拟培训组在任何时候都没有表现优于对照组。
对于精通基础腹腔镜技能的学员，额外的手术培训，尤其是在虚拟以及传统器官培训模型上的培训，其长期优势仍有待证明。
