腹腔镜学习曲线。

Laparoscopic learning curves.

机构信息

Pediatric Surgery Department. Gregorio Marañón Pediatric Hospital. Madrid (Spain).

Maxillofacial Surgery Department. San Carlos Clinical Hospital. Madrid (Spain).

出版信息

Cir Pediatr. 2021 Jan 1;34(1):20-27.

DOI:
Abstract

OBJECTIVES

Laparoscopic learning curves are slow, and there are no uniform surgical skill acquisition models. Therefore, our objective was to assess a laparoscopic skill learning program in individuals without any surgical experience, analyzing the learning curve by means of a certified custom-made simulator, and evaluating whether previous surgical experience had an impact on the learning curve.

MATERIAL AND METHODS

A certified custom-made simulator and laparoscopic instruments were used to assess 20 university students who performed 10 repetitions of 3 exercises of growing difficulty (eye-hand coordination, hand-hand coordination, and cutting). Three parameters were analyzed: total time with each hand, total mistakes with each hand, and three items of the OSATS technical skill scale. The two first exercises were compared with a group of 14 experienced surgeons. Statistical analysis using repeated-measures Anova and Student's t-test was carried out (p < 0.05).

RESULTS

Significant time improvement with each repetition was demonstrated in the three exercises. Curve stabilization was faster in surgeons (2-4 repetitions) than in students (8-9). Time reduction was noted in the first and second exercises in both groups, with 44.08% and 33.1% shorter times, respectively.

CONCLUSIONS

Individuals without surgical experience acquired basic laparoscopic skills using a custom-made simulator, which allows simple surgical techniques to be carried out in an inexpensive, accessible fashion. Previous surgical experience was associated with a shorter learning curve. The custom-made simulator allowed individuals with and without surgical experience to be distinguished from each other.

摘要

目的

腹腔镜学习曲线缓慢,并且没有统一的手术技能获取模型。因此,我们的目的是评估一个针对没有任何手术经验的个体的腹腔镜技能学习计划,通过认证的定制模拟器分析学习曲线,并评估先前的手术经验是否对学习曲线有影响。

材料和方法

使用认证的定制模拟器和腹腔镜器械评估了 20 名大学生,他们完成了 3 项逐渐增加难度的练习(眼手协调、手手协调和切割)各 10 次重复。分析了三个参数:双手的总用时、双手的总错误数以及 OSATS 技术技能量表的三个项目。前两个练习与 14 名经验丰富的外科医生进行了比较。使用重复测量方差分析和学生 t 检验进行了统计分析(p < 0.05)。

结果

在三个练习中,每个重复的时间都有显著的改善。在外科医生中,曲线稳定更快(2-4 次重复),而在学生中则较慢(8-9 次重复)。在两组中,前两个练习的时间都有所缩短,分别缩短了 44.08%和 33.1%。

结论

使用定制模拟器,没有手术经验的个体可以获得基本的腹腔镜技能,从而以经济实惠、易于获得的方式进行简单的手术技术。先前的手术经验与更短的学习曲线相关。定制模拟器允许区分有和没有手术经验的个体。

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