Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
Am J Obstet Gynecol. 2021 Nov;225(5):548.e1-548.e10. doi: 10.1016/j.ajog.2021.06.062. Epub 2021 Jun 18.
High-volume and fellowship-trained surgeons have superior outcomes. However, in gynecology, a large proportion of cases are performed by low-volume surgeons. Simulation has been shown to be useful in assessing surgical skill and may be a useful tool in hospital credentialing and maintenance of privileges.
To determine the correlation between a surgical case volume and fellowship training with performance on simulated procedural tasks.
A total of 108 obstetricians and gynecologists with laparoscopic privileges at 2 academic institutions completed a pre-test survey and performed 3 tasks on the LapSim laparoscopic virtual reality simulator. The pre-test survey inquired about the monthly laparoscopic case volume and prior training. Simulations included a basic skills task (peg transfer) followed by a procedural task (salpingectomy) of 2 difficulty levels (low and moderate). Spearman correlation and Wilcoxon tests were used to determine correlations between the survey responses and performance metrics.
Participants included 67 generalists (62%) and 41 fellowship-trained specialists (38%). There was an observed weak correlation among surgical volume (more than 6 cases per month), time to completion, and the amount of blood loss when performing the low-difficulty level salpingectomy (r=-0.32, P=.0007 and r=-0.29, P=.002, respectively). The economy of movement (instrument path length) was correlated to high surgical volume (r=-0.35, P=.0002). Compared with generalists, surgeons with fellowship training performed tasks faster (410.8 seconds [interquartile range, 309.7-595.2]) vs 530.2 seconds (interquartile range, 406.2-605.0; P=.0009), more efficiently at 6.1 m (interquartile range, 4.8-7.3) vs 8.1 m (interquartile range, 5.8-10.7; P=.0003), and with less blood loss at 21.7 mL (interquartile range, 11.8-37.7) vs 42.9 mL (interquartile range, 18.1-70.6; P=.002). Regarding the case volume and fellowship background, there was no difference in ovarian diathermy damage. In addition, there was no difference among most performance parameters for the peg transfer task and the moderate-difficulty salpingectomy procedure.
Surgical experience obtained through higher case volume and fellowship training correlate with higher performance scores during simulated procedural tasks. In a previous study, we found a similar correlation with simulated basic skills tasks. The current study is a continuation of an ongoing quality initiative to establish a summative assessment of laparoscopic surgical skills using virtual reality simulator for the maintenance of credentials among obstetrical and gynecologic surgeons. Future studies will compare the performance metrics from laparoscopic procedures performed on virtual reality simulator with the performance in the operating room and clinical outcomes.
高手术量和接受过专科培训的外科医生的手术效果更好。然而，在妇科领域，大量手术由低手术量的外科医生完成。模拟已被证明在评估手术技能方面非常有用，并且可能是医院认证和维持手术权限的有用工具。
确定手术量和专科培训与模拟手术任务表现之间的相关性。
在 2 所学术机构中具有腹腔镜手术权限的 108 名妇产科医生完成了一项预测试调查，并在 LapSim 腹腔镜虚拟现实模拟器上完成了 3 项任务。预测试调查询问了每月腹腔镜手术量和之前的培训情况。模拟包括一项基础技能任务（销转移），然后是两项难度级别（低和中）的手术任务（输卵管切除术）。使用 Spearman 相关和 Wilcoxon 检验来确定调查回复与绩效指标之间的相关性。
参与者包括 67 名普通外科医生（62%）和 41 名接受过专科培训的专家（38%）。手术量（每月超过 6 例）、完成时间和低难度级别输卵管切除术中失血量之间存在观察到的弱相关性（r=-0.32，P=.0007 和 r=-0.29，P=.002）。运动的经济性（器械路径长度）与高手术量相关（r=-0.35，P=.0002）。与普通外科医生相比，接受过专科培训的外科医生完成任务的速度更快（410.8 秒[四分位距，309.7-595.2]），速度为 530.2 秒（四分位距，406.2-605.0；P=.0009），效率更高，为 6.1 米（四分位距，4.8-7.3），8.1 米（四分位距，5.8-10.7；P=.0003），失血量更少，为 21.7 毫升（四分位距，11.8-37.7），42.9 毫升（四分位距，18.1-70.6；P=.002）。关于手术量和专科背景，卵巢电灼损伤没有差异。此外，在销转移任务和中等难度输卵管切除手术的大多数绩效参数方面没有差异。
通过更高的手术量和专科培训获得的外科经验与模拟手术任务中的更高表现评分相关。在之前的研究中，我们发现了与模拟基础技能任务相似的相关性。本研究是一项正在进行的质量倡议的延续，旨在使用虚拟现实模拟器建立腹腔镜手术技能的综合评估，以维持妇产科医生的手术权限。未来的研究将比较虚拟现实模拟器上进行的腹腔镜手术的绩效指标与手术室中的表现和临床结果。
