Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada.
Department of Surgery, Centre for Colon and Rectal Surgery, McGill University Health Centre, Montreal, QC, Canada.
Tech Coloproctol. 2020 Aug;24(8):863-871. doi: 10.1007/s10151-020-02251-4. Epub 2020 Jun 6.
Rectal purse string placement for transanal mesorectal excision is challenging, and practice is difficult. The objective of this study is to build an endoscopic rectal purse string simulator and provide evidence for the validity of its use.
A low-cost transanal endoscopic rectal purse string simulator was created and used to measure the performance of participants. Participants included general surgery residents, fellows, and staff surgeons from several Canadian university-affiliated institutions across Canada. The performance of the rectal purse string placement was measured by the time to completion of the task as well scoring with a modified objective structured assessment of technical skills (OSATS) score and a modified advanced laparoscopic suturing (ALS) score.
Thirty-nine participants were recruited into the study. Participants were split into three groups, based on prior experience with laparoscopic suturing, for the analysis of suturing a rectal purse string on the simulator based on three performance measures. There was a significant difference found in all three measures of performance in the three groups (time to completion p = 0.014, mean blinded OSATS score p = 0.007, mean blinded ALS score p = 0.020). Participants with previous laparoscopic suturing had significantly faster times to completion and higher skills scores when compared to residents (time: 5.1 ± 1.4 min vs 9.0 ± 4.8 min, p = 0.005; OSATS: 19.7 ± 2.8 vs 13.0 ± 5.8, p = 0.00398, ALS: 27.4 ± 4.0 vs 18.9 ± 8.5, p = 0.0151).
A transanal endoscopic purse string simulator was constructed and preliminary testing has shown variable performance based on prior laparoscopic suturing experience.
经肛门直肠系膜切除术的直肠荷包缝合具有挑战性，且操作难度大。本研究旨在构建一种内镜直肠荷包缝合模拟器，并为其使用的有效性提供证据。
创建了一种低成本的经肛门内镜直肠荷包缝合模拟器，并用于测量参与者的表现。参与者包括来自加拿大几个大学附属机构的普通外科住院医师、研究员和外科医生。通过完成任务的时间以及使用改良的客观结构化手术技能评估（OSATS）评分和改良的高级腹腔镜缝合（ALS）评分来衡量直肠荷包缝合的表现。
共招募了 39 名参与者参与研究。根据腹腔镜缝合的经验，将参与者分为三组，分析在模拟器上缝合直肠荷包的表现，使用三种性能指标进行分析。在三组中，所有三种性能指标均存在显著差异（完成时间 p=0.014，盲法 OSATS 评分的平均值 p=0.007，盲法 ALS 评分的平均值 p=0.020）。与住院医师相比，有过腹腔镜缝合经验的参与者完成时间更短，技能评分更高（时间：5.1±1.4 分钟 vs 9.0±4.8 分钟，p=0.005；OSATS：19.7±2.8 分 vs 13.0±5.8 分，p=0.00398；ALS：27.4±4.0 分 vs 18.9±8.5 分，p=0.0151）。
构建了一种经肛门内镜荷包缝合模拟器，初步测试表明，根据先前的腹腔镜缝合经验，表现存在差异。
