Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School, Tokyo, Japan.
PLoS One. 2021 Jan 13;16(1):e0244915. doi: 10.1371/journal.pone.0244915. eCollection 2021.
Technical proficiency of the operating surgeons is one of the most important factors in the safe performance of pancreaticoduodenectomy. The objective of the present study was to investigate whether surgical simulation of pancreatico-jejunostomy (PJ) using an inanimate biotissue model could improve the technical proficiency of hepato-biliary pancreatic (HBP) surgical fellows.
The biotissue drill consisted of sewing biotissues to simulate PJ. The drill was repeated a total of five times by each of the participant surgical fellows. The improvement of the surgical fellows' technical proficiency was evaluated by the supervisor surgeons using the Objective Structured Assessment of Technical Skills (OSATS) scale.
Eight HBP surgical fellows completed all the 5 drills. Both the OSATS 25 score and OSATS summary score, assessed by the two supervisor surgeons, improved steadily with repeated execution of the PJ drill. The average OSATS score, as assessed by both the supervisor surgeons, improved significantly from the first to the final drill, with a P value of 0.003 and 0.014 for the assessment by the two surgeons, respectively. On the other hand, no chronological alteration was observed in time of procedure (P = 0.788).
Repeated execution of a biotissue PJ drill improved the HBP surgical fellows' technical proficiency, as evaluated by OSATS. The present study lends support to the evidence that simulation training can contribute to shortening of the time required to negotiate the learning curve for the technique of PJ in the actual operating room.
手术医生的技术熟练程度是胰十二指肠切除术安全进行的最重要因素之一。本研究旨在探讨使用无生命的生物组织模型对胰肠吻合术（PJ）进行手术模拟是否可以提高肝胆胰腺（HBP）外科学员的技术熟练程度。
生物组织钻由缝合生物组织模拟 PJ 组成。每位参与者外科学员总共重复进行了 5 次钻取。主管外科医生使用客观结构化评估技术技能（OSATS）量表评估外科学员技术熟练程度的提高。
8 名 HBP 外科学员完成了所有 5 次钻取。两位主管外科医生评估的 OSATS 25 分和 OSATS 综合评分均随着 PJ 钻取的重复进行而稳步提高。两位主管外科医生评估的平均 OSATS 评分均从第一次钻取显著提高到最后一次钻取，两位外科医生的 P 值分别为 0.003 和 0.014。另一方面，手术时间没有随时间的推移而发生变化（P = 0.788）。
重复进行生物组织 PJ 钻取可提高 HBP 外科学员的技术熟练程度，OSATS 评估结果支持模拟训练可以有助于缩短实际手术中 PJ 技术学习曲线所需的时间。
