Fu Shangxi, Liu Xiao, Zhou Li, Zhou Meisheng, Wang Liming
Department of Organ Transplantation, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, 200003 China.
Department of Rheumatism, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, 200003 China.
Indian J Surg. 2017 Aug;79(4):288-293. doi: 10.1007/s12262-016-1468-z. Epub 2016 Mar 18.
The purpose of this study was to estimate the effects of surgical laparoscopic operation course on laparoscopic operation skills after the simulated training for medical students with relatively objective results via data gained before and after the practice course of laparoscopic simulator of the resident standardized trainees. Experiment 1: 20 resident standardized trainees with no experience in laparoscopic surgery were included in the inexperienced group and finished simulated cholecystectomy according to simulator videos. Simulator data was collected (total operation time, path length, average speed of instrument movement, movement efficiency, number of perforations, the time cautery is applied without appropriate contact with adhesions, number of serious complications). Ten attending doctors were included in the experienced group and conducted the operation of simulated cholecystectomy directly. Data was collected with simulator. Data of two groups was compared. Experiment 2: Participants in inexperienced group were assigned to basic group (receiving 8 items of basic operation training) and special group (receiving 8 items of basic operation training and 4 items of specialized training), and 10 persons for each group. They received training course designed by us respectively. After training level had reached the expected target, simulated cholecystectomy was performed, and data was collected. Experimental data between basic group and special group was compared and then data between special group and experienced group was compared. Results of experiment 1 showed that there is significant difference between data in inexperienced group in which participants operated simulated cholecystectomy only according to instructors' teaching and operation video and data in experienced group. Result of experiment 2 suggested that, total operation time, number of perforations, number of serious complications, number of non-cauterized bleeding and the time cautery is applied without appropriate contact with adhesions in special group were all superior to those in basic group. There was no statistical difference on other data between special group and basic group. Comparing special group with experienced group, data of total operation time and the time cautery is applied without appropriate contact with adhesions in experienced group was superior to that in special group. There was no statistical difference on other data between special group and experienced group. Laparoscopic simulators are effective for surgical skills training. Basic courses could mainly improve operator's hand-eye coordination and perception of sense of the insertion depth for instruments. Specialized training courses could not only improve operator's familiarity with surgeries, but also reduce operation time and risk, and improve safety.
本研究旨在通过住院医师规范化培训学员腹腔镜模拟器练习课程前后获取的数据，以相对客观的结果评估外科腹腔镜手术课程对医学生模拟训练后腹腔镜操作技能的影响。实验1：将20名无腹腔镜手术经验的住院医师规范化培训学员纳入无经验组，根据模拟器视频完成模拟胆囊切除术。收集模拟器数据（总手术时间、路径长度、器械移动平均速度、移动效率、穿孔次数、未适当接触粘连时使用电灼的时间、严重并发症数量）。将10名主治医生纳入有经验组，直接进行模拟胆囊切除术操作。用模拟器收集数据。比较两组数据。实验2：将无经验组参与者分为基础组（接受8项基本操作训练）和特殊组（接受8项基本操作训练和4项专项训练），每组10人。他们分别接受我们设计的培训课程。训练水平达到预期目标后，进行模拟胆囊切除术，并收集数据。比较基础组和特殊组之间的实验数据，然后比较特殊组和有经验组之间的数据。实验1结果表明，仅根据教员教学和操作视频进行模拟胆囊切除术操作的无经验组数据与有经验组数据存在显著差异。实验2结果表明，特殊组的总手术时间、穿孔次数、严重并发症数量、未烧灼出血次数以及未适当接触粘连时使用电灼的时间均优于基础组。特殊组与基础组在其他数据上无统计学差异。将特殊组与有经验组比较，有经验组的总手术时间和未适当接触粘连时使用电灼的时间数据优于特殊组。特殊组与有经验组在其他数据上无统计学差异。腹腔镜模拟器对外科手术技能训练有效。基础课程主要可提高操作者的手眼协调能力和对器械插入深度的感知。专项训练课程不仅可提高操作者对手术的熟悉程度，还可减少手术时间和风险，并提高安全性。
