Grund K E, Schweizer U, Zipfel A, Mothes B
Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Zentrum für Medizinische Forschung, Experimentelle Chirurgische Endoskopie, Universitätsklinikum Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Deutschland.
Chirurg. 2018 Dec;89(12):977-983. doi: 10.1007/s00104-018-0736-9.
Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative.
The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here.
Based on this need the long-proven Tübingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT.
In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom (Tübingen Orientophant) and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract. The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom.
Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.
胃肠道吻合口漏和穿孔是严重并发症，并发症发生率和死亡率都很高。传统治疗方案（尤其是再次手术）往往不尽人意。内镜下真空治疗（EVT）正越来越多地被用作一种有前景的替代方案。
EVT的使用需要高水平的介入性软性内镜操作能力，而并非每个外科医生都具备这种能力。在此需要特殊的培训项目。
基于这一需求，长期行之有效的图宾根软性内镜培训系统进行了改进，以满足外科医生的特殊要求，目前正在通过一个针对EVT的特殊培训模块进行扩展。
除了理论原理外，培训重点是学习软性内镜的操作技能。为此制定了一个两阶段流程：1）通过经过教学优化的抽象模型（图宾根定向模型）熟悉软性内镜的操作并学习空间定位，2）使用新开发的模拟患者培训模型进行EVT的学习和训练，该模型在上消化道和下消化道有各种缺损和脓肿腔。该操作可以像对待患者一样逐步进行实际操作培训，通过不同方法应用海绵，如外套管法和拖曳法。错误的后果和并发症处理也可以使用该模型进行理想的实际操作培训。
对首批课程系列的评估表明，外科医生能很快掌握内镜操作能力并学会掌握这一新操作。然而，此类课程的结构必须根据长期经验以最佳教学方式进行设计。医疗政策决策者应给予此类课程更多支持，以改善患者护理并提高患者安全性。
