LapTrain：腹腔镜胆囊切除术的多模态培训课程——一项随机对照试验的结果。
LapTrain: multi-modality training curriculum for laparoscopic cholecystectomy-results of a randomized controlled trial.
机构信息
Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
出版信息
Surg Endosc. 2018 Sep;32(9):3830-3838. doi: 10.1007/s00464-018-6110-7. Epub 2018 Feb 12.
BACKGROUND
Multiple training modalities for laparoscopy have different advantages, but little research has been conducted on the benefit of a training program that includes multiple different training methods compared to one method only. This study aimed to evaluate benefits of a combined multi-modality training program for surgical residents.
METHODS
Laparoscopic cholecystectomy (LC) was performed on a porcine liver as the pre-test. Randomization was stratified for experience to the multi-modality Training group (12 h of training on Virtual Reality (VR) and box trainer) or Control group (no training). The post-test consisted of a VR LC and porcine LC. Performance was rated with the Global Operative Assessment of Laparoscopic Skills (GOALS) score by blinded experts.
RESULTS
Training (n = 33) and Control (n = 31) were similar in the pre-test (GOALS: 13.7 ± 3.4 vs. 14.7 ± 2.6; p = 0.198; operation time 57.0 ± 18.1 vs. 63.4 ± 17.5 min; p = 0.191). In the post-test porcine LC, Training had improved GOALS scores (+ 2.84 ± 2.85 points, p < 0.001), while Control did not (+ 0.55 ± 2.34 points, p = 0.154). Operation time in the post-test was shorter for Training vs. Control (40.0 ± 17.0 vs. 55.0 ± 22.2 min; p = 0.012). Junior residents improved GOALS scores to the level of senior residents (pre-test: 13.7 ± 2.7 vs. 18.3 ± 2.9; p = 0.010; post-test: 15.5 ± 3.4 vs. 18.8 ± 3.8; p = 0.120) but senior residents remained faster (50.1 ± 20.6 vs. 25.0 ± 1.9 min; p < 0.001). No differences were found between groups on the post-test VR trainer.
CONCLUSIONS
Structured multi-modality training is beneficial for novices to improve basics and overcome the initial learning curve in laparoscopy as well as to decrease operation time for LCs in different stages of experience. Future studies should evaluate multi-modality training in comparison with single modalities.
TRIAL REGISTRATION
German Clinical Trials Register DRKS00011040.
背景
腹腔镜有多种培训模式，各有优势，但对于包括多种培训方法的培训计划与仅使用一种方法相比是否具有优势的研究较少。本研究旨在评估外科住院医师综合多模式培训计划的益处。
方法
在猪肝上进行腹腔镜胆囊切除术 (LC) 作为预测试。根据经验对随机分组为多模态训练组（12 小时虚拟现实 (VR) 和箱式训练）或对照组（无训练）进行分层。后测包括 VR LC 和猪 LC。由盲法专家使用全球腹腔镜手术技能评估 (GOALS) 评分进行评估。
结果
训练组 (n=33) 和对照组 (n=31) 在预测试中相似（GOALS：13.7±3.4 与 14.7±2.6；p=0.198；手术时间 57.0±18.1 与 63.4±17.5 分钟；p=0.191）。在猪 LC 的后测中，训练组的 GOALS 评分提高了 (+2.84±2.85 分，p<0.001)，而对照组没有 (+0.55±2.34 分，p=0.154)。与对照组相比，训练组在后测中的手术时间更短（40.0±17.0 与 55.0±22.2 分钟；p=0.012）。初级住院医师的 GOALS 评分提高到与高级住院医师相同的水平（预测试：13.7±2.7 与 18.3±2.9；p=0.010；后测：15.5±3.4 与 18.8±3.8；p=0.120），但高级住院医师仍然更快（50.1±20.6 与 25.0±1.9 分钟；p<0.001）。在后测 VR 训练器上，两组之间没有差异。
结论
结构化多模式培训有利于新手提高基本技能并克服腹腔镜手术的初始学习曲线，并减少不同经验阶段 LC 的手术时间。未来的研究应评估多模式培训与单一模式培训的比较。
试验注册
德国临床试验注册中心 DRKS00011040。
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