Kiesel Matthias, Beyers Inga, Kalisz Adam, Wöckel Achim, Löb Sanja, Schlaiss Tanja, Wulff Christine, Diessner Joachim
Department of Gynecology, University Hospital Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
Institute of Electric Power Systems (IfES), Leibniz Universität Hannover, Appelstraße 9A, 30167, Hannover, Germany.
3D Print Med. 2022 Jun 8;8(1):15. doi: 10.1186/s41205-022-00143-x.
Electrosurgical excisions are common procedures for treating cervical dysplasia and are often seen as minor surgeries. Yet, thorough training of this intervention is required, as there are considerable consequences of inadequate resections, e.g. preterm birth, the risk of recurrence, injuries and many more. Unfortunately, there is a lack of sufficiently validated possibilities of simulating electrosurgeries, which focus on high fidelity and patient safety.
A novel 3D printed simulator for examination and electrosurgical treatment of dysplastic areas of the cervix was compared with a conventional simulator. Sixty medical students experienced a seminar about cervical dysplasia. Group A underwent the seminar with the conventional and Group B with the novel simulator. After a theoretical introduction, the students were randomly assigned by picking a ticket from a box and went on to perform the hands-on training with their respective simulator. Each student first obtained colposcopic examination training. Then he or she performed five electrosurgical excisions (each). This was assessed with a validated score, to visualize their learning curve. Furthermore, adequate and inadequate resections and contacts between electrosurgical loop and vagina or speculum were counted. Both groups also assessed the seminar and their simulator with 18 questions (Likert-scales, 1-10, 1 = strongly agree / very good, 10 = strongly disagree / very bad). Group B additionally assessed the novel simulator with four questions (similar Likert-scales, 1-10).
Nine of 18 questions showed statistically significant differences favoring Group B (p < 0.05). Group B also achieved more adequate R0-resections and less contacts between electrosurgical loop and vagina or speculum. The learning curves of the performed resections favored the novel simulator of Group B without statistically significant differences. The four questions focusing on certain aspects of the novel simulator indicate high appreciation of the students with a mean score of 1.6 points.
The presented novel simulator shows several advantages compared to the existing model. Thus, novice gynecologists can be supported with a higher quality of simulation to improve their training and thereby patient safety.
电外科切除术是治疗宫颈发育异常的常见手术，通常被视为小手术。然而，由于切除不充分会带来相当严重的后果，如早产、复发风险、损伤等等，因此需要对这种干预措施进行全面培训。不幸的是，目前缺乏经过充分验证的、能够模拟电外科手术且注重高保真度和患者安全的方法。
将一种用于检查和电外科治疗宫颈发育异常区域的新型3D打印模拟器与传统模拟器进行比较。60名医学生参加了关于宫颈发育异常的研讨会。A组使用传统模拟器参加研讨会，B组使用新型模拟器。在进行理论介绍后，学生们通过从盒子里抽签的方式被随机分配，并使用各自的模拟器进行实践培训。每个学生首先接受阴道镜检查培训。然后，他或她各自进行五次电外科切除术。通过一个经过验证的评分来评估，以直观呈现他们的学习曲线。此外，统计充分和不充分的切除术数量以及电外科环与阴道或窥器之间的接触次数。两组还通过18个问题（李克特量表，1-10分，1 = 强烈同意/非常好，10 = 强烈不同意/非常差）对研讨会和他们的模拟器进行评估。B组还通过四个问题（类似李克特量表，1-10分）对新型模拟器进行评估。
18个问题中有9个显示出对B组有统计学显著优势（p < 0.05）。B组也实现了更多充分的R0切除，并且电外科环与阴道或窥器之间的接触更少。所进行的切除术的学习曲线有利于B组的新型模拟器，但无统计学显著差异。关注新型模拟器某些方面的四个问题显示学生的评价很高，平均得分为1.6分。
与现有模型相比，所展示的新型模拟器具有多个优势。因此，可以通过更高质量的模拟来支持新手妇科医生，以改善他们的培训，从而提高患者安全。
