Asfaw Zerubabbel K, Todd Rachel, Abasi Unwana, Marcela Bailez Maria, Narvaez Jacqueline, Carrasquilla Ana, Hernandez Centeno Raul, Yanowsky Reyes Guillermo, Zhang Linda P
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Hospital de Pediatría Dr. J.P. Garrahan, Buenos Aires, Argentina.
Surg Endosc. 2023 Feb;37(2):1528-1536. doi: 10.1007/s00464-022-09438-w. Epub 2022 Jul 19.
Laparoscopic surgery is rapidly expanding in low-and middle-income countries (LMICs), yet many surgeons in LMICs have limited formal training in laparoscopy. In 2017, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. In light of COVID-19, SAGES adapted GLAP to a virtual format with telesimulation. This study explores the feasibility and efficacy of virtual laparoscopic simulation training in resource-limited settings.
Participants from San Jose, Costa Rica, Leon, México, and Guadalajara, México enrolled in the virtual GLAP curriculum, meeting biweekly for 2-h didactic classes and 2-h hands-on live simulation practice. Surgical residents' laparoscopic skills were evaluated using the five Fundamentals of Laparoscopic Surgery (FLS) tasks during the initial and final weeks of the program. Participants also completed pre-and post-program surveys assessing their perception of simulation-based training.
The study cohort consisted of 16 surgical attendings and 20 general surgery residents. A minimum 70% response rate was recorded across all surveys in the study. By the end of GLAP, residents completed all five tasks of the FLS exam within less time relative to their performance at the beginning of the training program (p < 0.05). Respondents (100%) reported that the program was a good use of their time and that education via telesimulation was easily reproduced. Participants indicated that the practice sessions, guidance, and feedback offered by mentors were their favorite elements of the training.
A virtual simulation-based curriculum can be an effective strategy for laparoscopic skills training. Participants demonstrated an improvement in laparoscopic skills, and they appreciated the mentorship and opportunity to practice laparoscopic skills. Future programs can expand on using a virtual platform as a low-cost, effective strategy for providing laparoscopic skills training to surgeons in LMICs.
腹腔镜手术在低收入和中等收入国家（LMICs）迅速普及，但许多LMICs的外科医生接受的腹腔镜手术正规培训有限。2017年，美国胃肠和内镜外科医师协会（SAGES）实施了全球腹腔镜推进计划（GLAP），这是一项针对LMICs外科医生的基于模拟的面对面腹腔镜培训课程。鉴于新冠疫情，SAGES将GLAP改编为通过远程模拟的虚拟形式。本研究探讨了在资源有限的环境中进行虚拟腹腔镜模拟培训的可行性和有效性。
来自哥斯达黎加圣何塞、墨西哥莱昂和墨西哥瓜达拉哈拉的参与者参加了虚拟GLAP课程，每两周参加一次为时2小时的理论课程和2小时的现场实践模拟练习。在该计划的初始阶段和最后阶段，使用腹腔镜手术五项基本技能（FLS）任务评估外科住院医师的腹腔镜技能。参与者还完成了培训前后的调查问卷，评估他们对基于模拟的培训的看法。
研究队列包括16名外科主治医师和20名普通外科住院医师。该研究中所有调查的最低回复率为70%。到GLAP结束时，住院医师完成FLS考试的所有五项任务的时间相对于培训计划开始时的表现有所减少（p<0.05）。受访者（100%）报告称，该计划合理利用了他们的时间，并且通过远程模拟进行的教育很容易再现。参与者表示，导师提供的练习课程、指导和反馈是他们培训中最喜欢的部分。
基于虚拟模拟的课程可以成为腹腔镜技能培训的有效策略。参与者的腹腔镜技能有所提高，他们赞赏导师指导以及有机会练习腹腔镜技能。未来的计划可以进一步扩展使用虚拟平台，作为向LMICs的外科医生提供腹腔镜技能培训的低成本、有效策略。
