Surgical Endoscopy, University Hospital for General, Visceral and Transplant Surgery, Centre for Medical Research, Experimental Surgical Endoscopy, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany.
Surgical Endoscopy, Experimental Endoscopy, Research and Training, Centre for Medical Research, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany.
Chirurg. 2022 Jan;93(1):56-63. doi: 10.1007/s00104-021-01497-4. Epub 2021 Sep 27.
Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative.
The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here.
Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT.
In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom.
Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.
胃肠道吻合口不足和穿孔是严重的并发症，其并发症发生率和死亡率都很高。传统的治疗方法（尤其是再次手术）往往不尽人意。内镜下真空治疗（EVT）作为一种有前途的替代方法越来越受到关注。
EVT 的使用需要具备介入性软式内镜的高水平专业能力，而并非每个外科医生都具备这种能力。因此需要特殊的培训计划。
基于这一需求，我们对经过长期验证的图宾根软式内镜培训系统进行了修改，以满足外科医生的特殊需求，并正在通过 EVT 的特殊培训模块对其进行扩展。
除了理论原则外，培训还侧重于学习软式内镜的手动技能。为此，我们开发了一个两阶段的过程：1）熟悉软式内镜的操作，并通过教学优化的抽象模型（“图宾根定向模型”）学习空间定位；2）使用新开发的具有上消化道和下消化道各种不足和脓肿腔的类似患者的训练模型（“图宾根海绵模型”）学习和训练 EVT。可以像对待患者一样，逐步进行实际操作训练，通过使用不同的方法（如过管和拖动程序）进行海绵放置。还可以使用模型来实际训练错误和并发症管理的后果。
第一批课程系列的评估表明，外科医生能够非常快速地获得内镜专业能力，并学会掌握新程序。然而，此类课程的结构必须根据长期经验以最佳教学方式进行设计。医疗保健政策的决策者应该给予此类课程更多的支持，以改善患者护理并提高患者安全性。
