Buescher Julian Frederik, Mehdorn Anne-Sophie, Neumann Philipp-Alexander, Becker Felix, Eichelmann Ann-Kathrin, Pankratius Ulrich, Bahde Ralf, Foell Daniel, 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. 2018 Mar-Apr;75(2):516-526. doi: 10.1016/j.jsurg.2017.08.015. Epub 2017 Aug 31.
To investigate the effect of motion parameter feedback on laparoscopic basic skill acquisition and retention during a standardized box training curriculum.
A Lap-X Hybrid laparoscopic simulator was designed to provide individual and continuous motion parameter feedback in a dry box trainer setting. In a prospective controlled trial, surgical novices were randomized into 2 groups (regular box group, n = 18, and Hybrid group, n = 18) to undergo an identical 5-day training program. In each group, 7 standardized tasks on laparoscopic basic skills were completed twice a day on 4 consecutive days in fixed pairs. Additionally, each participant performed a simulated standard laparoscopic cholecystectomy before (day 1) and after training (day 5) on a LAP Mentor II virtual reality (VR) trainer, allowing an independent control of skill progress in both groups. A follow-up assessment of skill retention was performed after 6 weeks with repetition of both the box tasks and VR cholecystectomy.
Muenster University Hospital Training Center, Muenster, Germany.
Medical students without previous surgical experience.
Laparoscopic skills in both groups improved significantly during the training period, measured by the overall task performance time. The 6 week follow-up showed comparable skill retention in both groups. Evaluation of the VR cholecystectomies demonstrated significant decrease of operation time (p < 0.01), path length of the left and right instrument, and the number of movements of the left and right instruments for the Hybrid group (all p < 0.001), compared to the box group. Similar results were found at the assessment of skill retention.
Simulation training on both trainers enables reliable acquisition of laparoscopic basic skills. Furthermore, individual and continuous motion feedback improves laparoscopic skill enhancement significantly in several aspects. Thus, training systems with feedback of motion parameters should be considered to achieve long-term improvement of motion economy among surgical trainees.
在标准化的箱式训练课程中，研究运动参数反馈对腹腔镜基本技能习得和保持的影响。
设计了一种Lap-X混合腹腔镜模拟器，以便在干式箱式训练器环境中提供个体和连续的运动参数反馈。在一项前瞻性对照试验中，将外科新手随机分为两组（常规箱式组，n = 18；混合组，n = 18），接受相同的为期5天的训练计划。在每组中，连续4天每天两次以固定配对完成7项腹腔镜基本技能的标准化任务。此外，每位参与者在LAP Mentor II虚拟现实（VR）训练器上于训练前（第1天）和训练后（第5天）进行一次模拟标准腹腔镜胆囊切除术，从而能够独立控制两组的技能进展。6周后进行技能保持的随访评估，重复箱式任务和VR胆囊切除术。
德国明斯特明斯特大学医院培训中心。
无既往手术经验的医学生。
通过总体任务执行时间衡量，两组的腹腔镜技能在训练期间均有显著提高。6周随访显示两组的技能保持情况相当。对VR胆囊切除术的评估表明，与箱式组相比，混合组的手术时间（p < 0.01）、左右器械的路径长度以及左右器械的移动次数均显著减少（均p < 0.001）。在技能保持评估中也发现了类似结果。
两种训练器上的模拟训练均可可靠地习得腹腔镜基本技能。此外，个体和连续的运动反馈在多个方面显著改善了腹腔镜技能的提升。因此，应考虑采用具有运动参数反馈的训练系统，以实现外科实习生运动经济性的长期改善。
