Department of Pediatric Surgery, Fundación Hospitalaria, Children's Hospital, Buenos Aires, Argentina.
Department of Medical Device Design, Fundación Hospitalaria, Children's Hospital, Buenos Aires, Argentina.
J Pediatr Urol. 2018 Apr;14(2):137-143. doi: 10.1016/j.jpurol.2017.11.020. Epub 2018 Jan 31.
Acquiring surgical skills requires regular practice. Medical evidence supports that these skills can be learned outside the operating room (OR). The aim of the current study was to describe the first laparoscopic simulator for ureteral reimplantation (LAP-SPUR) following Lich- Gregoir technique.
LAP-SPUR was manufactured using reusable and disposable materials. The technique can be summarized in the following five steps: (1) a transperitoneal approach; (2) extra-vesical ureteral dissection; (3) detrusor division until exposing the mucosa; (4) reimplanting ureter into the new tunnel; and (5) reapproximation and suturing of the detrusor. LAP-SPUR was evaluated through a survey answered by urologists and surgeons. A 5-point Likert scale was employed for most items and the medians test was chosen to compare the response among physicians according to the number of laparoscopic surgical procedures performed per week (≤2 versus >2) and the experience in ureteral reimplantation of the respondent as a dichotomous variable (0 versus ≥1 repairs).
Thirty-four surveys were answered. The simulator was reported to: have a very high level of realism by the experts; be a reproducible procedure with similar anatomical structures and working space to pediatric patients by the non-experts; be extremely useful, easy and ergonomic for laparoscopic training outside the OR; be lightweight and portable for straightforward transportation; be inexpensive; and be reusable and have low maintenance requirements. It was found to provide a secure environment for trainees, to enhance cognitive knowledge acquisitions, and to increase technical performance. Only tissue handling was non-significant when groups were compared.
Augmenting surgical dexterity using LAP-SPUR offered great promise because maneuvers could be rehearsed over and over until they were mastered. Of the urologists and surgeons who were evaluated, 100% reported lack of training at their institutions; therefore, all of them would definitely benefit by practicing with LAP-SPUR to enhance technical skill acquirement. Further development and validation are still needed to assess its true benefits.
获得手术技能需要定期练习。医学证据表明，这些技能可以在手术室（OR）之外学习。本研究的目的是描述首例采用 Lich-Gregoir 技术的腹腔镜输尿管再植术（LAP-SPUR）模拟器。
LAP-SPUR 使用可重复使用和一次性材料制造。该技术可以概括为以下五个步骤：（1）经腹腔入路；（2）经膀胱外输尿管解剖；（3）膀胱切开至暴露黏膜；（4）将输尿管重新植入新隧道；（5）膀胱吻合和缝合。LAP-SPUR 通过泌尿科医生和外科医生回答的调查进行评估。大多数项目采用 5 分李克特量表，选择中位数检验比较每周进行的腹腔镜手术次数（≤2 次与>2 次）和受访者输尿管再植经验（0 次与≥1 次）的医生之间的反应。
34 份调查问卷得到了回答。专家认为模拟器具有非常高的逼真度；非专家认为，该模拟器是一种可重复的程序，具有类似的解剖结构和工作空间，适用于儿科患者；对于 OR 之外的腹腔镜培训非常有用、简单且符合人体工程学；模拟器重量轻且便于携带，易于运输；价格低廉；可重复使用且维护要求低。研究发现，它为学员提供了一个安全的环境，有助于提高认知知识的获取，并提高技术性能。只有组织处理在组间比较时不具有统计学意义。
使用 LAP-SPUR 增强手术灵活性具有很大的潜力，因为可以反复进行操作练习，直到熟练掌握为止。在接受评估的泌尿科医生和外科医生中，100%的人报告在他们的机构缺乏培训；因此，所有人通过使用 LAP-SPUR 进行练习来增强技术技能获取，肯定会受益。仍需要进一步开发和验证来评估其真正的益处。
