Molinas Carlos Roger, Binda Maria Mercedes, Campo Rudi
Neolife - Medicina y Cirugia Reproductiva, Avenida Brasilia 760, 1434 Asuncion, Paraguay.
European Academy of Gynaecological Surgery, Leuven, Belgium.
Gynecol Surg. 2017;14(1):12. doi: 10.1186/s10397-017-1015-3. Epub 2017 Jul 7.
Training of basic laparoscopic psychomotor skills improves both acquisition and retention of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial (RCT) was performed to evaluate the effect of different pre-training programs in hand-eye coordination (HEC) upon the learning curve of LICK.
The study was performed in a private center in Asunción, Paraguay, by 60 residents/specialists in gynaecology with no experience in laparoscopic surgery. Participants were allocated in three groups. In phase , a baseline test was performed (, three repetitions). In phase 2, participants underwent different training programs for HEC (60 repetitions): G1 with both the dominant hand (DH) and the non-dominant hand (NDH), G2 with the DH only, G3 none. In phase 3, a post HEC/pre LICK training test was performed (, three repetitions). In phase 4, participants underwent a standardized training program for LICK (60 repetitions). In phase 5, a final test was performed (, three repetitions). The score was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). For both HEC and LICK, the group learning curves fitted better to the two-phase exponential decay model. For HEC with the DH, G1 and G2 started from a similar point, but G1 reached a lower plateau at a higher speed. In G1, the DH curve started from a lower point than the NDH curve, but both curves reached a similar plateau at comparable speeds. For LICK, all groups started from a similar point, but immediately after HEC training and before LICK training, G1 scored better than the others. All groups reached a similar plateau but with a different decay, G1 reaching this plateau faster than the others groups.
This study demonstrates that pre-training in HEC with both the DH and the NDH shortens the LICK learning curve.
基础腹腔镜操作技能培训可提高更高级腹腔镜任务的习得和保留能力，比如腹腔镜体内打结（LICK）。本随机对照试验（RCT）旨在评估不同手眼协调（HEC）预训练方案对LICK学习曲线的影响。
该研究在巴拉圭亚松森的一家私立中心开展，由60名无腹腔镜手术经验的妇科住院医师/专科医生参与。参与者被分为三组。在阶段1，进行了基线测试（3次重复）。在阶段2，参与者接受了不同的HEC训练方案（60次重复）：G1组使用优势手（DH）和非优势手（NDH），G2组仅使用DH，G3组不进行训练。在阶段3，进行了HEC训练后/LICK训练前测试（3次重复）。在阶段4，参与者接受了LICK标准化训练方案（60次重复）。在阶段5，进行了最终测试（3次重复）。分数基于任务完成系统所花费的时间。绘制分数并使用非线性回归模型将学习曲线拟合为每个参与者（个体曲线）和每个组（组曲线）的一阶段和两阶段指数衰减模型。对于HEC和LICK，组学习曲线都更符合两阶段指数衰减模型。对于使用DH的HEC，G1组和G2组从相似的点开始，但G1组以更高的速度达到了更低的平稳期。在G1组中，DH曲线起点低于NDH曲线，但两条曲线以相当的速度达到了相似的平稳期。对于LICK，所有组从相似的点开始，但在HEC训练后且在LICK训练前，G1组得分高于其他组。所有组都达到了相似的平稳期，但衰减不同，G1组比其他组更快达到这个平稳期。
本研究表明，使用DH和NDH进行HEC预训练可缩短LICK学习曲线。
