King's College London, London, United Kingdom.
MRC Centre for Transplantation, Kings College London, London, United Kingdom.
J Surg Educ. 2018 May-Jun;75(3):758-766. doi: 10.1016/j.jsurg.2017.09.005. Epub 2017 Sep 30.
OBJECTIVE: To perform the first validation of a full procedural virtual reality robotic training module and analysis of novice surgeon's learning curves. DESIGN: Participants completed the bladder neck dissection task and urethrovesical anastomosis task (UVA) as part of the prostatectomy module. Surgeons completed feedback questionnaires assessing the realism, content, acceptability and feasibility of the module. Novice surgeons completed a 5.5-hour training programme using both tasks. SETTING: King's College London, London. PARTICIPANTS: 13 novice, 24 intermediate and 8 expert surgeons completed the validation study. RESULTS: Realism was scored highly for BDN (mean 3.4/5) and UVA (3.74/5), as was importance of BDN (4.32/5) and UVA (4.6/5) for training. It was rated as a feasible (3.95/5) and acceptable (4/5) tool for training. Experts performed significantly better than novice group in 6 metrics in the UVA including time (p = 0.0005), distance by camera (p = 0.0010) and instrument collisions (p = 0.0033), as well as task-specific metrics such as number of unnecessary needle piercing points (p = 0.0463). In novice surgeons, a significant improvement in performance after training was seen in many metrics for both tasks. For bladder neck dissection task, this included time (p < 0.0001), instrument collisions (p = 0.0013) and total time instruments are out of view (p = 0.0251). For UVA, this included time (p = 0.0135), instrument collisions (p = 0.0066) and task-specific metrics such as injury to the urethra (p = 0.0032) and bladder (p = 0.0189). CONCLUSIONS: Surgeons found this full procedural VR training module to be a realistic, feasible and acceptable component for a robotic surgical training programme. Construct validity was proven between expert and novice surgeons. Novice surgeons have shown a significant learning curve over 5.5 hours of training, suggesting this module could be used in a surgical curriculum for acquisition of technical skills. Further implementation of this module into the curriculum and continued analysis would be beneficial to gauge how it can be fully utilised.
目的:对全程序虚拟现实机器人培训模块进行首次验证,并分析新手外科医生的学习曲线。
设计:参与者完成了膀胱颈部解剖任务和尿道膀胱吻合术(UVA)作为前列腺切除术模块的一部分。外科医生完成了反馈问卷,评估模块的真实性、内容、可接受性和可行性。新手外科医生使用这两个任务完成了 5.5 小时的培训计划。
地点:伦敦国王学院。
参与者:13 名新手、24 名中级和 8 名专家外科医生完成了验证研究。
结果:对于 BDN(平均 3.4/5)和 UVA(3.74/5),真实性评分较高,BDN(4.32/5)和 UVA(4.6/5)对培训的重要性评分也较高。它被评为一种可行的(3.95/5)和可接受的(4/5)培训工具。在 UVA 的 6 项指标中,专家的表现明显优于新手组,包括时间(p=0.0005)、相机距离(p=0.0010)和器械碰撞(p=0.0033),以及任务特定指标,如不必要的针穿刺点数量(p=0.0463)。在新手外科医生中,在两个任务的许多指标中,培训后表现都有显著提高。对于膀胱颈部解剖任务,这包括时间(p<0.0001)、器械碰撞(p=0.0013)和器械完全看不见的总时间(p=0.0251)。对于 UVA,这包括时间(p=0.0135)、器械碰撞(p=0.0066)和任务特定指标,如尿道(p=0.0032)和膀胱(p=0.0189)损伤。
结论:外科医生发现这个全程序虚拟现实培训模块是机器人手术培训计划中一个现实、可行和可接受的组成部分。在专家和新手外科医生之间证明了结构有效性。新手外科医生在 5.5 小时的培训中表现出显著的学习曲线,这表明该模块可用于技术技能获取的外科课程。进一步将该模块纳入课程并持续分析将有助于评估如何充分利用该模块。
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