Ballouhey Quentin, Micle Liviu, Grosos Céline, Robert Yohan, Binet Aurélien, Arnaud Alexis, Abbo Olivier, Lardy Hubert, Longis Bernard, Bréaud Jean, Fourcade Laurent
1 Service de Chirurgie Viscérale Pédiatrique , Hôpital des Enfants, Limoges, France .
2 Service de Chirurgie Pédiatrique de Grenoble , Faculté de médecine de Grenoble-Alpes, Grenoble, France .
J Laparoendosc Adv Surg Tech A. 2018 Jun;28(6):760-765. doi: 10.1089/lap.2017.0263. Epub 2018 Apr 9.
A key concern regarding laparoscopic pyloromyotomy (LP) lies with the process of learning this skill. The learning processes for open pyloromyotomy and LP appear to be different, with an earlier increased risk of perforation or incomplete pyloromyotomy (IP) for LP. Our aim was to develop a simple simulation tool to reduce these specific complications.
A model of hypertrophic pyloric stenosis was created and inserted into a pediatric laparoscopic surgery simulator. A cohort of experts completed a six-item questionnaire, using a 4-point scale regarding the model's realistic nature and accuracy. Evaluation of the LP procedure was based on a dedicated Objective Structured Assessment of Technical Skills score. Surgical residents and students were enrolled for the final evaluation to assess the relative performance of trainees who had practiced with this model (Group 1) versus those who had observed its use (Group 2).
Reproducibility of the model construction was considered to be satisfactory. The experts agreed that the model accurately simulated essential components of LP (mean 3.03 ± 0.7). They scored significantly better than the residents (27.2 ± 1.8 versus 22.8 ± 2.9; P < .001), with a lower rate of complications. Group 1 (39 trainees) performed significantly better than Group 2 (26 trainees), with a significant decrease in the risk of an IP (P < .05).
This model appears to be sufficiently accurate to teach LP. In light of this, it can be considered to be an efficient tool for LP simulation teaching in our fellows' educational program.
腹腔镜幽门肌切开术（LP）的一个关键问题在于学习这项技能的过程。开放幽门肌切开术和LP的学习过程似乎有所不同，LP在早期发生穿孔或幽门肌切开不完全（IP）的风险增加。我们的目的是开发一种简单的模拟工具，以减少这些特定并发症。
创建肥厚性幽门狭窄模型并将其插入小儿腹腔镜手术模拟器中。一组专家完成了一份六项问卷，使用4分制来评估模型的逼真程度和准确性。LP手术的评估基于专门的客观结构化技术技能评分。招募外科住院医师和学生进行最终评估，以评估使用该模型进行练习的学员（第1组）与观察过该模型使用的学员（第2组）的相对表现。
模型构建的可重复性被认为是令人满意的。专家们一致认为该模型准确模拟了LP的基本组成部分（平均3.03±0.7）。他们的得分明显高于住院医师（27.2±1.8对22.8±2.9；P<.001），并发症发生率较低。第1组（39名学员）的表现明显优于第2组（26名学员），IP风险显著降低（P<.05）。
该模型似乎足够准确，可以用于教授LP。鉴于此，它可被视为我们学员教育计划中LP模拟教学的有效工具。
