Brown Chris, Robinson David, Egan Richard, Hopkins Luke, Abdelrahman Tarig, Powell Arfon, Pollitt M John, Lewis Wyn G
Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom.
Department of Surgery, Morriston Hospital, Swansea, United Kingdom.
J Laparoendosc Adv Surg Tech A. 2019 Sep;29(9):1128-1134. doi: 10.1089/lap.2019.0332. Epub 2019 Jul 30.
Simulation training is strongly advocated by 24/7 risk-rich professions because swift learning curve inflection point attainment delivers earlier competence; the left-shift effect. The aim of this study was to determine the value of haptic laparoscopic virtual reality simulation, by iterative benchmark exercise ( = 8), before simulated laparoscopic appendicectomy (SLA); the hypothesis was that favorable benchmark learning curve trajectories would be associated with improved SLA competence when compared with consultant expert performance. A 28-trainee cohort completed 1349 Laparoscopic Haptic Virtual Reality Skills (LHVRS) tasks, during which 19 ergonomic variables were assessed by virtual interface, including force feedback (Surgicalscience.com), before 153 SLAs. Primary outcome measure was SLA composite competence score related to six consultant trainer experts. Of the eight LHVRS tasks, the three with the steepest learning curve trajectories correlated with better median overall SLA competence scores, namely tissue grasping/lifting (rho = 0.362, = .049), fine dissection (rho = 0.388, = .028), and camera navigation (rho = 0.518, = .007); fine dissection was the only haptic laparoscopic virtual reality simulation task that predicted a SLA score within a Youden index defined, 70% of the consultant expert level (area under curve [AUC] = 0.803, = .028). A significant SLA learning curve emerged, with a learning curve trajectory inflection point at the fourth SLA attempt (first SLA 30.5% versus fourth SLA score 76.0%, gradient 76°, = .010). Learning curve trajectory can be measured, influenced, and accelerated significantly; a pronounced left-shift effect, with translational potential for enhanced shorter training time and improved patient safety.
全天候面临高风险的职业强烈提倡模拟训练，因为能迅速达到学习曲线的拐点从而更早具备能力，即左移效应。本研究的目的是通过在模拟腹腔镜阑尾切除术（SLA）前进行迭代基准测试（n = 8）来确定触觉腹腔镜虚拟现实模拟的价值；假设是与顾问专家表现相比，有利的基准学习曲线轨迹将与SLA能力的提高相关。一个由28名受训者组成的队列完成了1349项腹腔镜触觉虚拟现实技能（LHVRS）任务，在此期间，在153次SLA之前，通过虚拟界面评估了19个人机工程学变量，包括力反馈（Surgicalscience.com）。主要结局指标是与六位顾问培训专家相关的SLA综合能力得分。在八项LHVRS任务中，学习曲线轨迹最陡的三项任务与更好的SLA总体能力中位数得分相关，即组织抓取/提起（rho = 0.362，P = 0.049）、精细解剖（rho = 0.388，P = 0.028）和摄像头导航（rho = 0.518，P = 0.007）；精细解剖是唯一一项在约登指数定义范围内预测SLA得分达到顾问专家水平70%的触觉腹腔镜虚拟现实模拟任务（曲线下面积[AUC] = 0.803，P = 0.028）。出现了显著的SLA学习曲线，在第四次SLA尝试时出现学习曲线轨迹的拐点（第一次SLA得分为30.5%，第四次SLA得分为76.0%，斜率76°，P = 0.010）。学习曲线轨迹可以被测量、影响并显著加速；具有明显的左移效应，具有缩短训练时间和提高患者安全性的转化潜力。
