Bian Zhengqian, Zhang Yan, Ye Guangyao, Guo Feng, Mu Yifei, Fan Yinghui, Zhou Xiang, Zheng Qing, Konge Lars, Wang Zheng
Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai.
Guangdong Academy for Medical Simulation (GAMS), Guangzhou, Guangdong, China.
Ann Med Surg (Lond). 2023 Jun 5;85(7):3491-3496. doi: 10.1097/MS9.0000000000000798. eCollection 2023 Jul.
This randomized controlled trial compared the efficacy of virtual-reality (VR) simulator training and surgical training on live pigs to explore the most effective and evidence-based training modality.
Thirty-six novice surgical residents without independent laparoscopic experience were randomly paired with a peer and randomized into three groups: VR simulator group (dyad training on LapSim VR simulators), pig surgery group (training on live, anesthetized pigs) and control group (training by a lecture on laparoscopic surgery, surgical videos and textbooks). After 6 h of training, all participants performed a simulated cholecystectomy procedure using a pig liver with adherent gallbladder working in pairs. All procedures were video-recorded and the recordings were saved on USB-sticks in a blinded fashion identifiable only by the unique participant number. All video-recordings were scored blindly and independently by two expert raters using the Global Operative Assessment of Laparoscopic Skills (GOALS) assessment instrument.
The performances in the three groups were significantly different, less than 0.001. Both the VR simulation training group and the live pigs training group performed significantly better than the control group, both values less than 0.001. However, there was no significant difference in the performance of the two simulation-based training groups, =0.66.
Novice surgical trainees can benefit from both VR simulator training and pig surgery simulation compared with traditional studying and there was no significant difference between the two modalities. The authors recommend that VR simulators should be used for basic training of laparoscopic skills and surgery on live animals should be reserved for higher-level surgical training.
本随机对照试验比较了虚拟现实（VR）模拟器训练与在活猪上进行手术训练的效果，以探索最有效且基于证据的训练方式。
36名没有独立腹腔镜经验的新手外科住院医师随机与一名同行配对，并随机分为三组：VR模拟器组（在LapSim VR模拟器上进行双人训练）、猪手术组（在麻醉的活猪上进行训练）和对照组（通过腹腔镜手术讲座、手术视频和教科书进行训练）。经过6小时的训练后，所有参与者使用带有粘连胆囊的猪肝成对进行模拟胆囊切除术。所有手术均进行视频记录，并以盲法将记录保存在U盘上，仅通过唯一的参与者编号进行识别。两名专家评分者使用腹腔镜技能全球手术评估（GOALS）评估工具对所有视频记录进行盲法和独立评分。
三组的表现存在显著差异，P<0.001。VR模拟训练组和活猪训练组的表现均明显优于对照组，P值均小于0.001。然而，两个基于模拟的训练组的表现没有显著差异，P=0.66。
与传统学习相比，新手外科受训者可以从VR模拟器训练和猪手术模拟中受益，且这两种方式之间没有显著差异。作者建议VR模拟器应用于腹腔镜技能的基础训练，而在活体动物上进行的手术应保留用于更高水平的外科训练。
