Nomura Tsutomu, Mamada Yasuhiro, Nakamura Yoshiharu, Matsutani Takeshi, Hagiwara Nobutoshi, Fujita Isturo, Mizuguchi Yoshiaki, Fujikura Terumichi, Miyashita Masao, Uchida Eiji
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
Academic Quality and Development Office, Nippon Medical School, Tokyo, Japan.
Asian J Endosc Surg. 2015 Nov;8(4):408-12. doi: 10.1111/ases.12209. Epub 2015 Jul 28.
Definitive assessment of laparoscopic skill improvement after virtual reality simulator training is best obtained during an actual operation. However, this is impossible in medical students. Therefore, we developed an alternative assessment technique using an augmented reality simulator.
Nineteen medical students completed a 6-week training program using a virtual reality simulator (LapSim). The pretest and post-test were performed using an object-positioning module and cholecystectomy on an augmented reality simulator(ProMIS). The mean performance measures between pre- and post-training on the LapSim were compared with a paired t-test.
In the object-positioning module, the execution time of the task (P < 0.001), left and right instrument path length (P = 0.001), and left and right instrument economy of movement (P < 0.001) were significantly shorter after than before the LapSim training. With respect to improvement in laparoscopic cholecystectomy using a gallbladder model, the execution time to identify, clip, and cut the cystic duct and cystic artery as well as the execution time to dissect the gallbladder away from the liver bed were both significantly shorter after than before the LapSim training (P = 0.01).
Our training curriculum using a virtual reality simulator improved the operative skills of medical students as objectively evaluated by assessment using an augmented reality simulator instead of an actual operation. We hope that these findings help to establish an effective training program for medical students.
虚拟现实模拟器训练后腹腔镜技能提升的最终评估最好在实际手术中进行。然而，这对医学生来说是不可能的。因此，我们开发了一种使用增强现实模拟器的替代评估技术。
19名医学生使用虚拟现实模拟器（LapSim）完成了为期6周的训练课程。使用增强现实模拟器（ProMIS）上的物体定位模块和胆囊切除术进行了预测试和后测试。使用配对t检验比较了LapSim训练前后的平均性能指标。
在物体定位模块中，LapSim训练后任务的执行时间（P < 0.001）、左右器械路径长度（P = 0.001）以及左右器械的运动经济性（P < 0.001）均显著短于训练前。关于使用胆囊模型进行腹腔镜胆囊切除术的改进，识别、夹闭和切断胆囊管及胆囊动脉的执行时间以及将胆囊从肝床分离的执行时间在LapSim训练后均显著短于训练前（P = 0.01）。
我们使用虚拟现实模拟器的训练课程提高了医学生的手术技能，这是通过使用增强现实模拟器而非实际手术进行评估客观得出的。我们希望这些发现有助于为医学生建立一个有效的训练计划。
