Consalvo Vincenzo, Salsano Vincenzo
Clinique Clementville, Montpellier, France, Universita degli Studi di Salerno, Fisciano, Italy.
Bariatric Surgery, Clinique du Parc Montpellier, Clinique Clementville, Montpellier, France.
Surg Technol Int. 2017 Oct 12;31:25-30.
Ventral incisional hernia is one of the most common procedures in laparoscopic surgery, however, it requires proper training before doing it in the operating room. We propose a low-cost mechanical simulator with a new optical system to learn the basic steps of the procedure and improve surgical laparoscopic skill.
From November 3, 2014 to January 4, 2015, five residents and five surgeons with no prior laparoscopic experience, as well as two laparoscopic expert surgeons, participated in our study. They repeated the procedure three times per day for seven days. From January 10, 2015 to April 21, 2015, the five trained and five non-trained residents performed (each) five real laparoscopic ventral or median incisional hernia repairs under senior supervision. Operative time, decision making capabilities, number of errors, laparoscopic skill, and depth perception were compared between the two groups.
A multiple regression (R) model was calculated and F-test showed a significant relation between operative time and numbers of procedures with the laparoscopic simulator (p<0.001) for the resident and non-laparoscopic surgeons groups and a multiple R-squared = 0.9974 (highly significant) of the model. No statistical difference was found between residents and non-laparoscopic surgeons (p<0.001), but both groups reached the same level as the expert surgeons after intensive training. Kruskal-Wallis was used to show an increased operative time for non-trained group. Pearson test and t-test showed a lower number of errors and failure in the trained group.
These results indicate that this new model of simulator could shorten the learning curve of surgical trainees for laparoscopic incisional hernia.
腹直肌切口疝修补术是腹腔镜手术中最常见的手术之一，然而，在手术室进行该手术前需要进行适当的培训。我们提出了一种低成本的机械模拟器，其具有新的光学系统，用于学习该手术的基本步骤并提高腹腔镜手术技能。
2014年11月3日至2015年1月4日，五名住院医师、五名无腹腔镜手术经验的外科医生以及两名腹腔镜专家外科医生参与了我们的研究。他们连续七天每天重复该手术三次。2015年1月10日至2015年4月21日，五名经过培训的住院医师和五名未经过培训的住院医师在上级监督下各进行了五次真实的腹腔镜腹直肌或正中切口疝修补术。比较了两组之间的手术时间、决策能力、错误数量、腹腔镜手术技能和深度感知。
计算了多元回归（R）模型，F检验显示住院医师组和非腹腔镜外科医生组的手术时间与使用腹腔镜模拟器进行的手术次数之间存在显著关系（p<0.001），且该模型的多元决定系数R² = 0.9974（高度显著）。住院医师组和非腹腔镜外科医生组之间未发现统计学差异（p<0.001），但经过强化培训后，两组均达到了与专家外科医生相同的水平。使用Kruskal-Wallis检验显示未培训组的手术时间延长。Pearson检验和t检验显示培训组的错误数量和失败次数较少。
这些结果表明，这种新型模拟器模型可以缩短外科实习生腹腔镜切口疝修补术的学习曲线。
