Rodriguez Jose R, Yañez Ricardo, Cifuentes Ignacio, Varas Julian, Dagnino Bruno
Santiago, Chile.
From the Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Catolica de Chile.
Plast Reconstr Surg. 2016 Oct;138(4):739e-747e. doi: 10.1097/PRS.0000000000002456.
Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model.
Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant.
Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively.
Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.
目前，尚无仅基于非活体模型的有效培训项目。作者旨在开发并验证一种基于非活体模型的显微外科培训项目，并评估技能向活体大鼠模型的迁移情况。
对三年级普通外科住院医师进行了一个为期17节的培训项目，在离体鸡模型上进行动脉和静脉端端吻合。手术过程由两名不知情的专家使用经过验证的整体和特定量表（客观结构化技术技能评估）及经过验证的检查表进行记录和评分。评估手术时间和通畅率。使用手部动作分析来测量动作经济性。培训后，住院医师在活体大鼠上进行动脉和静脉端端吻合。将结果与同模型中的六位经验丰富的外科医生进行比较。p<0.05的值被认为具有统计学意义。
实现了学习曲线。十名住院医师提高了他们动脉[10（范围8至10）对28（范围27至29），p<0.05；以及8（范围7至9）对28（范围27至28），p<0.05]和静脉[8（范围8至11）对28（范围27至28），p<0.05；以及8（范围7至9）对28（范围27至29），p<0.05]的整体和特定客观结构化技术技能评分中位数。两个手术的检查表评分也有所提高（p<0.05）。受训者比经验丰富的外科医生速度慢且效率低（p<0.05）。在活体大鼠中，30分钟时动脉和静脉的通畅率分别为100%和50%。
受训者显著获得了显微外科技能，达到了与经验丰富的外科医生相似的水平。所获得的技能迁移到了更复杂的活体模型中。
