Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
John Goligher Surgery Unit, St. James University Hospital, Leeds, UK.
Surg Endosc. 2018 Mar;32(3):1165-1173. doi: 10.1007/s00464-017-5788-2. Epub 2017 Aug 24.
Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal.
Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors.
The participants performed equally well when presented with a "straight-forward" anatomy [Group A vs. Group B-time sec: 445.5 vs. 496 p = 0.64-NOM: 437 vs. 413 p = 0.88-PL cm: 1317 vs. 1059 p = 0.32-per: 0.5 vs. 0 p = 0.22-NCB: 0 vs. 0 p = 0.71-DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score-Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η = 0.32-Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η = 0.28] and committed less errors (Damage to Vital Structures-DVS, SCD: 4 vs. 0 p = 0.03 η =0.34, DA: 0 vs. 1 p = 0.02 η = 0.22). in the cases with more challenging anatomies.
These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.
当今的外科医生面临着前所未有的挑战；这需要一种新的术前准备方法，考虑到每个病例的具体检查。在这项研究中，我们研究了针对术前实践的患者特定的心理演练，并评估与通用心理演练相比，这种方法是否具有额外的效果。
16 名医学生接受了模拟腹腔镜胆囊切除术（SLC）的培训。在基线评估后，他们被随机分为两组，并要求完成涉及不同解剖变异的三个 SLC。在每个手术前，A 组使用预先准备的检查表进行心理演练，B 组使用与 SLC 解剖变异相匹配的虚拟模型进行心理演练。两位盲评人使用模拟器提供的指标和能力评估工具（CAT）对两组的表现进行了比较。
当呈现“简单”解剖结构时，两组参与者表现相当[组 A 与组 B-时间 sec：445.5 与 496，p=0.64-NOM：437 与 413，p=0.88-PL cm：1317 与 1059，p=0.32-per：0.5 与 0，p=0.22-NCB：0 与 0，p=0.71-DVS：0 与 0，p=0.2]；然而，B 组表现明显更好[组 A 与组 B 总 CAT 评分-短胆囊管（SCD）：20.5 与 26.31，p=0.02，η=0.32-双胆囊动脉（DA）：24.75 与 30.5，p=0.03，η=0.28]，并且犯的错误更少（重要结构损伤-DVS，SCD：4 与 0，p=0.03，η=0.34，DA：0 与 1，p=0.02，η=0.22）。在解剖结构更具挑战性的病例中。
这些结果表明，针对特定患者的准备工作结合解剖模型和心理演练可能会提高复杂手术的操作质量。
