Bedetti Benedetta, Schnorr Philipp, Schmidt Joachim, Scarci Marco
Department of Thoracic Surgery, Malteser Hospital, Bonn, Germany.
Department of Thoracic Surgery, University College of London Hospitals, London, UK.
J Vis Surg. 2017 May 4;3:61. doi: 10.21037/jovs.2017.03.23. eCollection 2017.
During the last three decades, minimally invasive surgery has become common practice in all kinds of surgical disciplines and, in Thoracic Surgery, the minimally invasive approach is recommended as the treatment of choice for early-stage non-small cell lung cancer. Nevertheless, all over the world a large number of lobectomies is still performed by conventional open thoracotomy and not as video-assisted thoracic surgery (VATS), which shows the need of a proper training for this technique. Development and improvement of surgical skills are not only challenging and time-consuming components of the training curriculum for resident or fellow surgeons, but also for more experienced consultants learning new techniques. The rapid evolution of medical technologies like VATS or robotic surgery requires an evolution of the existing educational models to improve cognitive and procedural skills before reaching the operating room in order to increase patient safety. Nowadays, in the Thoracic Surgery field, there is a wide range of simulation-based training methods for surgeons starting or wanting to improve their learning curve in VATS. Aim is to overcome the learning curve required to successfully master this new technique in a brief time. In general, the basic difference between the various learning techniques is the distinction between "dry" and "wet" lab modules, which mainly reflects the use of synthetic or animal-model-based materials. Wet lab trainings can be further sub-divided into modules, where living anaesthetized animals are used, and modules, where only animal tissues serve as basis of the simulation-based training method. In the literature, the role of wet lab in Thoracic Surgery is still debated.
在过去三十年中,微创手术已在各类外科领域成为常规操作,在胸外科,微创方法被推荐作为早期非小细胞肺癌的首选治疗方式。然而,在全球范围内,仍有大量肺叶切除术是通过传统开胸手术进行的,而非电视辅助胸腔镜手术(VATS),这表明该技术需要适当的培训。手术技能的发展和提升不仅是住院医师或进修医师培训课程中具有挑战性且耗时的部分,对于学习新技术的经验更丰富的会诊医师来说也是如此。像VATS或机器人手术这样的医疗技术的快速发展要求现有教育模式不断演进,以便在进入手术室之前提高认知和操作技能,从而提高患者安全性。如今,在胸外科领域,有多种基于模拟的培训方法可供刚开始进行VATS或希望改善其学习曲线的外科医生使用。目的是在短时间内克服成功掌握这项新技术所需的学习曲线。一般来说,各种学习技术的基本区别在于“干式”和“湿式”实验室模块之间的差异,这主要反映了合成材料或基于动物模型的材料的使用。湿式实验室培训可进一步细分为使用活体麻醉动物的模块和仅使用动物组织作为基于模拟的培训方法基础的模块。在文献中,湿式实验室在胸外科中的作用仍存在争议。