Brodaric Alen Maximillian, Wong Ngar Lok Joshua, Falon Jessica, Wong Jean, Cheng Kai, Whereat Sarah, Storey David
Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
ANZ J Surg. 2023 Jul-Aug;93(7-8):1817-1824. doi: 10.1111/ans.18495. Epub 2023 May 4.
Endoscopic retrograde cholangio-pancreatography (ERCP) has higher rates of morbidity and mortality compared to upper or lower gastrointestinal tract endoscopy. The availability of magnetic resonance cholangiopancreatography means ERCP is usually performed for therapeutic purposes. Simulation could provide an adjunct to patient-based training in ERCP however models to date have been unconvincing.
This ERCP simulation model was constructed from moulded meshed silicone by co-designers: Jean Wong and Kai Cheng. The anatomical orientation was based on a combination of anatomical specimens, sectional atlases, and the clinical experience of expert endoscopists.
From March to October 2022, we recruited 5 surgeons/gastroenterologists to the expert group and 14 medical students, junior doctors, or surgical/gastroenterological trainees to the novice group. Most experts either agreed or strongly agreed that the simulation anatomy appearance (100%), anatomical orientation (83%), tactile feedback (66%), traversal actions (67%), cannula positioning (66%) and papilla cannulation (67%) resembled the procedure in humans. Experts statistically significantly outperformed novices in obtaining a cannulating position (80% vs. 14%, P = 0.006) and successful papilla cannulation (80% vs. 7%, P = 0.0015) on their first attempt. The novice group had statistically significant improvements in time to obtaining a cannulating position (3.53 vs. 11.5 min, P = 0.006) and passing the duodenoscope to the papilla (2.55 vs. 4 passes, P = 0.009).
The simulator showed statistically significant results in face, content, and construct validity. A follow-up validation study should recruit participants across multiple institutions. External validity could be assessed by comparing expert proceduralist simulator performance against clinical ERCP performance.
与上消化道或下消化道内镜检查相比，内镜逆行胰胆管造影术（ERCP）的发病率和死亡率更高。磁共振胰胆管造影的应用意味着ERCP通常用于治疗目的。模拟可以为基于患者的ERCP培训提供辅助手段，然而迄今为止的模型并不令人信服。
这个ERCP模拟模型由共同设计者Jean Wong和Kai Cheng用模制网状硅胶构建而成。解剖学定位基于解剖标本、断层图谱以及专家内镜医师的临床经验的综合。
2022年3月至10月，我们招募了5名外科医生/胃肠病学家进入专家组，14名医学生、初级医生或外科/胃肠病学实习生进入新手组。大多数专家要么同意要么强烈同意模拟解剖外观（100%）、解剖学定位（83%）、触觉反馈（66%）、穿越动作（67%）、插管定位（66%）和乳头插管（67%）与人体操作相似。在首次尝试时，专家在获得插管位置（80%对14%，P = 0.006）和成功乳头插管（80%对7%，P = 0.0015）方面在统计学上显著优于新手。新手组在获得插管位置的时间（3.53对11.5分钟，P = 0.006）和将十二指肠镜通过到乳头的次数（2.55对4次，P = 0.009）方面有统计学上的显著改善。
该模拟器在表面效度、内容效度和结构效度方面显示出统计学上的显著结果。后续的验证研究应招募多个机构的参与者。外部效度可以通过比较专家操作模拟器的表现与临床ERCP表现来评估。
