Department of General Surgery, The Dingli Clinical College of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou.
Department of Clinical Medicine, Suzhou Medical College of Soochow University, Suzhou.
Int J Surg. 2023 Oct 1;109(10):2953-2961. doi: 10.1097/JS9.0000000000000582.
Intestinal anastomosis is a clinical procedure widely used to reconstruct the digestive tract, but authentic laparoscopic intracorporeal intestinal anastomosis (LIIA) models are lacking. However, three-dimensional (3D) printing can enable authentic and reusable models. In this paper, a novel cost-effective 3D-printing training model of LIIA is designed and the authenticity and validity of the model are tested.
A fused deposition modeling 3D printing and an assembled lab model were built to test LIIA. Fifteen surgeons were required to perform LIIA, and their operation score and time were recorded and analyzed. Five experts were invited to assess the face and content validity of the models. A study was also performed to further evaluate and validate the learning curve of surgeons.
The difference in modified anastomosis objective structured assessment of technical skills (MAOSATS) scores between the expert, intermediate, and novice groups were significant (64.1±1.8: 48.5±1.7: 29.5±3.1, P <0.001). In addition, the operation time of the procedure was statistically different for all three groups (21.5±1.9: 30.6±2.8:70.7±4.0, P<0.001 ). The five experts rated the face and content validity of the model very highly, with the median being four out of five. Surgeons who underwent repeated training programs showed improved surgical performance. After eight training sessions, the novices' performance was similar to that of the average level of untrained intermediates, while the operation scores of the intermediates were close to that of the average level of experts.
In this study, it is found that the LIIA model exhibits excellent face, content, and construct validity. Repeated simulation training of the LIIA training program improved the surgeon's operative performance, so the model is considered one of the most effective methods for LIIA training and assessment of surgical quality in the future and for reducing healthcare costs.
肠吻合术是一种广泛应用于重建消化道的临床操作，但真实的腹腔镜肠内吻合术（LIIA）模型却缺乏。然而，三维（3D）打印可以实现真实和可重复使用的模型。在本文中，设计了一种新颖的、具有成本效益的 LIIA 3D 打印培训模型，并对模型的真实性和有效性进行了测试。
构建了熔融沉积建模 3D 打印和组装实验室模型来测试 LIIA。要求 15 名外科医生进行 LIIA，记录并分析他们的手术评分和时间。邀请了 5 名专家对模型的表面和内容有效性进行评估。还进行了一项研究，以进一步评估和验证外科医生的学习曲线。
专家、中级和初级组之间改良吻合术客观结构化评估技术技能（MAOSATS）评分的差异具有统计学意义（64.1±1.8: 48.5±1.7: 29.5±3.1，P<0.001）。此外，所有三组的手术时间均有统计学差异（21.5±1.9: 30.6±2.8:70.7±4.0，P<0.001）。五位专家对模型的表面和内容有效性给予了非常高的评价，中位数为五分制的四分。接受重复培训计划的外科医生的手术表现得到了改善。经过八次培训课程后，新手的表现与未经训练的中级水平相当，而中级的手术评分则接近专家的平均水平。
在这项研究中，发现 LIIA 模型具有优异的表面、内容和结构有效性。重复模拟训练 LIIA 培训计划提高了外科医生的手术表现，因此该模型被认为是未来 LIIA 培训和评估手术质量以及降低医疗保健成本的最有效方法之一。
