Portelli M, Bianco S F, Bezzina T, Abela J E
Department of Surgery, Mater Dei Hospital, Msida, Malta.
Department of Pathology, Mater Dei Hospital, Msida, Malta.
Ann R Coll Surg Engl. 2020 Nov;102(9):672-684. doi: 10.1308/rcsann.2020.0178. Epub 2020 Aug 21.
Since its inception, laparoscopic surgery has evolved and new techniques have been developed due to technological advances. This requires a different and more complex skill set in comparison with open surgery. Reduced working hours, less training time and patient safety factors demand that such skills need to be achieved outside the operating theatre environment. Several studies have been published and have determined the effectiveness of virtual reality training. We aimed to compare virtual reality training with the traditional apprenticeship method of training and determine whether it can supplement or replace the traditional apprenticeship model. We also aimed to perform a meta-analysis of the literature and develop conclusions with respect to the benefits achieved by adding virtual reality training on a regular basis to surgical training programmes.
A literature search was carried out on PubMed, MEDLINE, EMBASE and Google Scholar academic search engines using the MESH terms 'randomised controlled trials', 'virtual reality', 'laparoscopy', 'surgical education' and 'surgical training'. All randomised controlled trials published to January 2018 comparing virtual reality training to apprenticeship training were included. Data were collected on improved dexterity, operative performance and operating times. Each outcome was calculated with 95% confidence intervals and with intention-to-treat analysis; 24 randomised controlled trials were analysed.
Meta-analytical data were extracted for time, path length, instrument handling, tissue handling, error scores and objective structure assessment of technical skills scoring. There was significant improvement in individual trainee skill in all meta-analyses ( 0.0002).
This meta-analysis shows that virtual reality not only improves efficiency in the trainee's surgical practice but also improves quality with reduced error rates and improved tissue handling.
自腹腔镜手术问世以来，由于技术进步，其不断发展并涌现出新的技术。与开放手术相比，这需要一套不同且更为复杂的技能。工作时间减少、培训时间缩短以及患者安全因素要求在手术室环境之外掌握这些技能。已有多项研究发表并确定了虚拟现实培训的有效性。我们旨在比较虚拟现实培训与传统师徒培训方法，并确定其是否能够补充或取代传统师徒培训模式。我们还旨在对文献进行荟萃分析，并就定期在外科培训项目中增加虚拟现实培训所带来的益处得出结论。
在PubMed、MEDLINE、EMBASE和谷歌学术搜索引擎上进行文献检索，使用医学主题词“随机对照试验”“虚拟现实”“腹腔镜检查”“外科教育”和“外科培训”。纳入所有截至2018年1月发表的比较虚拟现实培训与师徒培训的随机对照试验。收集有关灵活性提高、手术操作表现和手术时间的数据。每个结果均以95%置信区间和意向性分析进行计算；分析了24项随机对照试验。
提取了有关时间、路径长度、器械操作、组织操作、错误评分和技术技能评分的客观结构化评估的荟萃分析数据。在所有荟萃分析中，个体受训者技能均有显著提高（P<0.0002）。
这项荟萃分析表明，虚拟现实不仅提高了受训者手术实践的效率，还通过降低错误率和改善组织操作提高了质量。
