Brinkmann Christian, Fritz Mathias, Pankratius Ulrich, Bahde Ralf, Neumann Philipp, Schlueter Steffen, Senninger Norbert, Rijcken Emile
Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
J Surg Educ. 2017 Jul-Aug;74(4):724-735. doi: 10.1016/j.jsurg.2016.12.009. Epub 2017 Jan 13.
Simulation training improves laparoscopic performance. Laparoscopic basic skills can be learned in simulators as box- or virtual-reality (VR) trainers. However, there is no clear recommendation for either box or VR trainers as the most appropriate tool for the transfer of acquired laparoscopic basic skills into a surgical procedure.
Both training tools were compared, using validated and well-established curricula in the acquirement of basic skills, in a prospective randomized trial in a 5-day structured laparoscopic training course. Participants completed either a box- or VR-trainer curriculum and then applied the learned skills performing an ex situ laparoscopic cholecystectomy on a pig liver. The performance was recorded on video and evaluated offline by 4 blinded observers using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. Learning curves of the various exercises included in the training course were compared and the improvement in each exercise was analyzed.
Surgical Skills Lab of the Department of General and Visceral Surgery, University Hospital Muenster.
Surgical novices without prior surgical experience (medical students, n = 36).
Posttraining evaluation showed significant improvement compared with baseline in both groups, indicating acquisition of laparoscopic basic skills. Learning curves showed almost the same progression with no significant differences. In simulated laparoscopic cholecystectomy, total GOALS score was significantly higher for the box-trained group than the VR-trained group (box: 15.31 ± 3.61 vs. VR: 12.92 ± 3.06; p = 0.039; Hedge׳s g* = 0.699), indicating higher technical skill levels.
Despite both systems having advantages and disadvantages, they can both be used for simulation training for laparoscopic skills. In the setting with 2 structured, validated and almost identical curricula, the box-trained group appears to be superior in the better transfer of basic skills into an experimental but structured surgical procedure.
模拟训练可提高腹腔镜操作水平。腹腔镜基本技能可在诸如箱式或虚拟现实（VR）训练器等模拟器中学习。然而，对于箱式训练器和VR训练器哪一种作为将所习得的腹腔镜基本技能转化为手术操作的最合适工具，尚无明确建议。
在一个为期5天的结构化腹腔镜训练课程的前瞻性随机试验中，使用经过验证且成熟的基本技能获取课程，对这两种训练工具进行比较。参与者完成箱式或VR训练器课程，然后运用所学技能在猪肝上进行体外腹腔镜胆囊切除术。操作过程被录像，由4名不知情的观察者使用腹腔镜技能全球手术评估（GOALS）评分进行离线评估。比较训练课程中各种练习的学习曲线，并分析每项练习的进步情况。
明斯特大学医院普通及内脏外科手术技能实验室。
无手术经验的外科新手（医学生，n = 36）。
训练后评估显示，两组与基线相比均有显著改善，表明习得腹腔镜基本技能。学习曲线显示进展几乎相同，无显著差异。在模拟腹腔镜胆囊切除术中，箱式训练组的总GOALS评分显著高于VR训练组（箱式：15.31±3.61 vs. VR：12.92±3.06；p = 0.039；Hedge's g* = 0.699），表明技术水平更高。
尽管两种系统都有优缺点，但均可用于腹腔镜技能的模拟训练。在有两种结构化、经过验证且几乎相同课程的情况下，箱式训练组在将基本技能更好地转化为实验性但结构化的手术操作方面似乎更具优势。
