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虚拟现实模拟训练对腹腔镜胆囊切除术手术操作绩效的影响：随机临床试验的荟萃分析。

The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials.

机构信息

Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences. University College London, London, UK.

UCL Division of Surgery and Interventional Science, University College London, London, UK.

出版信息

BJS Open. 2022 Jul 7;6(4). doi: 10.1093/bjsopen/zrac086.

DOI:10.1093/bjsopen/zrac086
PMID:35849132
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9291386/
Abstract

BACKGROUND: Simulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training (VRT) and other training methods in laparoscopic cholecystectomy. METHODS: MEDLINE (PubMed), Embase (Ovid SP), Web of Science, Scopus and LILACS were searched for trials randomizing participants to VRT or no additional training (NAT) or simulation training (ST). Outcomes of interest were the reported performance using global rating scores (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS), error counts and time to completion of task during laparoscopic cholecystectomy on either porcine models or humans. Study quality was assessed using the Cochrane Risk of Bias Tool. PROSPERO ID: CRD42020208499. RESULTS: A total of 351 titles/abstracts were screened and 96 full texts were reviewed. Eighteen RCT were included and 15 manuscripts had data available for meta-analysis. Thirteen studies compared VRT and NAT, and 4 studies compared VRT and ST. One study compared VRT with NAT and ST and reported GRS only. Meta-analysis showed OSATS score (mean difference (MD) 6.22, 95%CI 3.81 to 8.36, P < 0.001) and time to completion of task (MD -8.35 min, 95%CI 13.10 to 3.60, P = <0.001) significantly improved after VRT compared with NAT. No significant difference was found in GOALS score. No significant differences were found between VRT and ST groups. Intraoperative errors were reported as reduced in VRT groups compared with NAT but were not suitable for meta-analysis. CONCLUSION: Meta-analysis suggests that performance measured by OSATS and time to completion of task is improved with VRT compared with NAT for junior trainee in laparoscopic cholecystectomy. However, conclusions are limited by methodological heterogeneity and more research is needed to quantify the potential benefit to surgical training.

摘要

背景：模拟培训可以提高外科受训者的学习曲线。本研究旨在系统地回顾评价初级外科受训者在接受虚拟现实培训（VRT）和其他模拟培训方法后在腹腔镜胆囊切除术方面表现的随机临床试验（RCT）。

方法：检索 MEDLINE（PubMed）、Embase（Ovid SP）、Web of Science、Scopus 和 LILACS，以随机分配参与者接受 VRT 或无额外培训（NAT）或模拟培训（ST）的试验。感兴趣的结果是使用全球评分（GRS）、客观结构化手术技能评估（OSATS）和腹腔镜技能全球评估（GOALS）报告的表现、错误计数和腹腔镜胆囊切除术的完成任务时间，使用猪模型或人体。使用 Cochrane 偏倚风险工具评估研究质量。PROSPERO ID：CRD42020208499。

结果：共筛选出 351 个标题/摘要，回顾了 96 篇全文。纳入 18 项 RCT，15 篇文献有可供分析的数据。13 项研究比较了 VRT 和 NAT，4 项研究比较了 VRT 和 ST。一项研究比较了 VRT 与 NAT 和 ST，仅报告了 GRS。荟萃分析显示，与 NAT 相比，VRT 后 OSATS 评分（平均差异（MD）6.22，95%CI 3.81 至 8.36，P<0.001）和完成任务时间（MD-8.35 分钟，95%CI 13.10 至 3.60，P<0.001）显著提高。GOALS 评分无显著差异。VRT 组和 ST 组之间无显著差异。与 NAT 相比，VRT 组术中错误减少，但不适合进行荟萃分析。

结论：荟萃分析表明，与 NAT 相比，VRT 可提高初级受训者腹腔镜胆囊切除术的 OSATS 和完成任务时间的表现。然而，由于方法学异质性，结论受到限制，需要进一步研究来量化对手术培训的潜在益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/2b74158f658c/zrac086f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/51bf7235b6b8/zrac086f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/14773263813e/zrac086f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/b3a1e158f50c/zrac086f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/fe8e404e9838/zrac086f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/43ec6bfdc401/zrac086f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/2b74158f658c/zrac086f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/51bf7235b6b8/zrac086f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/14773263813e/zrac086f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/b3a1e158f50c/zrac086f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/fe8e404e9838/zrac086f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/43ec6bfdc401/zrac086f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abe1/9291386/2b74158f658c/zrac086f6.jpg

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[8]
Author response to: The impact of virtual-reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials.

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本文引用的文献

[1]
A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents' Operative Performance and Decreases Skill Variability: Cohort Study.

Ann Surg. 2022-12-1

[2]
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J Surg Educ. 2021

[3]
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Ann R Coll Surg Engl. 2020-11

[4]
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Int J Surg. 2019-4-14

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Surg Endosc. 2018-9-7

[6]
Surgical Simulation: Markers of Proficiency.

J Surg Educ. 2018-7-6

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Issues of cost-benefit and cost-effectiveness for simulation in health professions education.

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[8]
LapTrain: multi-modality training curriculum for laparoscopic cholecystectomy-results of a randomized controlled trial.

Surg Endosc. 2018-2-12

[9]
Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland.

BMJ Open. 2017-11-15

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J Surg Res. 2017-12

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