Orlando Megan S, Thomaier Lauren, Abernethy Melinda G, Chen Chi Chiung Grace
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 301 Mason Lord Drive Suite 3200, Baltimore, MD, 21224, USA.
Surg Endosc. 2017 Aug;31(8):3306-3312. doi: 10.1007/s00464-016-5363-2. Epub 2017 Jan 11.
Although simulation training beneficially contributes to traditional surgical training, there are less objective data on simulation skills retention.
To investigate the retention of laparoscopic and robotic skills after simulation training.
We present the second stage of a randomized single-blinded controlled trial in which 40 simulation-naïve medical students were randomly assigned to practice peg transfer tasks on either laparoscopic (N = 20, Fundamentals of Laparoscopic Surgery, Venture Technologies Inc., Waltham, MA) or robotic (N = 20, dV-Trainer, Mimic, Seattle, WA) platforms. In the first stage, two expert surgeons evaluated participants on both tasks before (Stage 1: Baseline) and immediately after training (Stage 1: Post-training) using a modified validated global rating scale of laparoscopic and robotic operative performance. In Stage 2, participants were evaluated on both tasks 11-20 weeks after training.
Of the 40 students who participated in Stage 1, 23 (11 laparoscopic and 12 robotic) underwent repeat evaluation. During Stage 2, there were no significant differences between groups in objective or subjective measures for the laparoscopic task. Laparoscopic-trained participants' performances on the laparoscopic task were improved during Stage 2 compared to baseline measured by time to task completion, but not by the modified global rating scale. During the robotic task, the robotic-trained group demonstrated superior economy of motion (p = .017), Tissue Handling (p = .020), and fewer errors (p = .018) compared to the laparoscopic-trained group. Robotic skills acquisition from baseline with no significant deterioration as measured by modified global rating scale scores was observed among robotic-trained participants during Stage 2.
Robotic skills acquired through simulation appear to be better maintained than laparoscopic simulation skills.
This study is registered on ClinicalTrials.gov (NCT02370407).
尽管模拟训练对传统外科手术训练有益，但关于模拟技能保持的客观数据较少。
研究模拟训练后腹腔镜和机器人手术技能的保持情况。
我们展示了一项随机单盲对照试验的第二阶段，40名未接触过模拟训练的医学生被随机分配在腹腔镜（N = 20，腹腔镜手术基础，Venture Technologies公司，马萨诸塞州沃尔瑟姆）或机器人（N = 20，dV-Trainer，Mimic公司，华盛顿州西雅图）平台上练习移钉任务。在第一阶段，两名专家外科医生在训练前（阶段1：基线）和训练后立即（阶段1：训练后）使用改良的经过验证的腹腔镜和机器人手术操作性能整体评分量表对参与者进行两项任务的评估。在第二阶段，在训练后11 - 20周对参与者进行两项任务的评估。
参与第一阶段的40名学生中，23名（11名腹腔镜组和12名机器人组）接受了重复评估。在第二阶段，腹腔镜任务的客观或主观测量指标在两组之间没有显著差异。与基线相比，接受腹腔镜训练的参与者在第二阶段完成任务的时间方面，腹腔镜任务的表现有所改善，但改良整体评分量表未显示出改善。在机器人任务中，与接受腹腔镜训练的组相比，接受机器人训练的组在动作经济性（p = 0.017）、组织处理（p = 0.020）方面表现更优，且错误更少（p = 0.018）。在第二阶段，接受机器人训练的参与者中观察到从基线开始获得的机器人技能经改良整体评分量表评分测量无显著下降。
通过模拟获得的机器人技能似乎比腹腔镜模拟技能保持得更好。
本研究已在ClinicalTrials.gov（NCT02370407）注册。
