Coelho Ana, Mendes Luís, Correia-Pinto Jorge, Moreira-Pinto João
1 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho , Braga, Portugal .
2 ICVS/3B's-PT; Government Associate Laboratory , Braga/Guimarães, Portugal .
J Laparoendosc Adv Surg Tech A. 2018 Sep;28(9):1121-1124. doi: 10.1089/lap.2017.0652. Epub 2018 Mar 13.
Laparoscopic percutaneous inguinal ring suturing (PIRS) is a valuable technique to repair indirect inguinal hernias in children. The aim of the study was to show the preliminary results of training in an easy-to-build dry-lab model for laparoscopic PIRS technique.
The dry-lab model consists of two surgical gloves (being the smaller inside the larger). The entry of the glove is tied with a rubber letting a 5-mm trocar within it (optic). Carbon dioxide is inflated through the trocar at 8 mmHg pressure. The four long fingers of the glove simulate four internal inguinal rings. Eighteen participants without significant laparoscopic experience were asked to visualize a video showing a laparoscopic PIRS performed in a 4-year-old girl with a right inguinal hernia followed by a video showing the same technique performed in our dry-lab model. They were then asked to repeat the procedure in each of the four fingers, and the procedures were recorded. Two surgeons using the task-specific checklists (TSCs), global rating scale of operative performance (GRS), and time for the whole procedure evaluated the performance blindly.
We found significant improvement in median TSC (P < .05) and median GRS each time the procedure was repeated (P < .05). There was significant shortening each time the procedure was repeated (P < .05), except between the third and fourth finger (P = .068).
Our dry-lab model might be a good option for starting laparoscopic PIRS training.
腹腔镜经皮腹股沟环缝合术（PIRS）是修复小儿腹股沟斜疝的一项重要技术。本研究旨在展示在一个易于构建的腹腔镜PIRS技术干式模拟模型中进行培训的初步结果。
干式模拟模型由两只手术手套组成（较小的手套套在较大的手套内）。手套开口处用橡胶扎紧，将一个5毫米的套管针置于其中（用于放置腹腔镜）。通过套管针以8毫米汞柱的压力充入二氧化碳。手套的四个长手指模拟四个腹股沟内环。18名没有丰富腹腔镜经验的参与者先观看一段在一名患有右侧腹股沟疝的4岁女孩身上进行腹腔镜PIRS手术的视频，随后观看一段在我们的干式模拟模型中进行相同手术的视频。然后要求他们在四个手指中的每一个上重复该操作，并记录操作过程。两名外科医生使用特定任务检查表（TSC）、手术操作整体评分量表（GRS）以及整个手术过程的时间对操作进行盲法评估。
我们发现每次重复操作时，TSC中位数（P < 0.05）和GRS中位数均有显著改善（P < 0.05）。每次重复操作时手术时间均显著缩短（P < 0.05），但第三次和第四次手指操作之间除外（P = 0.068）。
我们的干式模拟模型可能是开展腹腔镜PIRS培训的一个不错选择。
