Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi, 10408, South Korea.
Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
Surg Endosc. 2022 Aug;36(8):6260-6270. doi: 10.1007/s00464-022-09214-w. Epub 2022 Apr 25.
Transanal minimally invasive surgery (TAMIS) is technically demanding and requires extensive training. We developed the TAMIS simulator model by remodeling an existing laparoscopic training system to educate trainees and analyzed their learning curves.
Between March 2020 and June 2020, 12 trainees performed TAMIS simulator training sessions. The total operative time, including specimen removal and wound closure, was recorded. The wound closure and specimen quality, trainee self-confidence, and supervisor evaluation of technical performance were documented. A moving average was used to analyze the number of training sessions required to stabilize the procedure time, while a cumulative sum analysis was performed to identify that required to reach proficiency with each item.
Each trainee completed 20 TAMIS simulator training sessions. The median total procedure time was 13 min (range, 4-60 min), which stabilized after 15 training sessions. The median times for specimen removal and wound closure were 3 min (range, 1-18 min) and 10 min (range, 2-50 min), respectively, which stabilized after 7 and 15 training sessions, respectively. The mean specimen and wound closure quality scores were 2.9 ± 0.9 (on a scale from 1 to 4) and 2.3 ± 1.1 (on a scale from 1 to 4), respectively, competencies in which were achieved after 16 and 20 training sessions, respectively. The mean trainee self-confidence and supervisor evaluation of technical performance scores were 2.4 ± 1.2 (on a scale from 1 to 5) and 2.7 ± 1.2 (on a scale from 1 to 5), respectively, competencies in which were achieved after 20 and 17 training sessions, respectively.
Trainees required 15 training sessions to stabilize the procedure time and 16-20 training sessions to demonstrate competencies with the TAMIS simulator model. We expect this simulator model may help surgeons more rapidly acquire the skills required for TAMIS.
经肛门微创手术（TAMIS）技术要求高，需要广泛的培训。我们通过改造现有的腹腔镜培训系统来开发 TAMIS 模拟器模型，以对学员进行教育，并分析他们的学习曲线。
2020 年 3 月至 6 月期间，12 名学员进行了 TAMIS 模拟器培训课程。记录总手术时间，包括标本取出和伤口闭合。记录伤口闭合和标本质量、学员自信心以及主管对技术表现的评估。使用移动平均值来分析稳定手术时间所需的培训课程数量，而累积和分析则用于确定达到每个项目熟练程度所需的课程数量。
每位学员完成了 20 次 TAMIS 模拟器培训课程。中位总手术时间为 13 分钟（范围为 4-60 分钟），在 15 次培训课程后稳定下来。标本取出和伤口闭合的中位时间分别为 3 分钟（范围为 1-18 分钟）和 10 分钟（范围为 2-50 分钟），分别在 7 次和 15 次培训课程后稳定下来。标本和伤口闭合质量的平均得分为 2.9±0.9（评分范围为 1-4）和 2.3±1.1（评分范围为 1-4），分别在 16 次和 20 次培训课程后达到。学员自信心和主管对技术表现的评估平均得分为 2.4±1.2（评分范围为 1-5）和 2.7±1.2（评分范围为 1-5），分别在 20 次和 17 次培训课程后达到。
学员需要 15 次培训课程来稳定手术时间，需要 16-20 次培训课程来展示 TAMIS 模拟器模型的能力。我们预计这个模拟器模型可以帮助外科医生更快地获得 TAMIS 所需的技能。
