Jirapinyo Pichamol, Thompson Christopher C
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Gastrointest Endosc. 2024 Jan;99(1):41-49. doi: 10.1016/j.gie.2023.07.045. Epub 2023 Aug 1.
Endoscopic suturing is a complex skill with broad applications. The aim of this study was to develop and validate a novel endoscopic suturing simulator and scoring system for the purse-string suture pattern.
This was a prospective study of an endoscopic suturing simulator that consists of a circular opening representing a dilated gastrojejunal anastomosis of Roux-en-Y gastric bypass with 12 small target holes around its circumference. Purse-string suturing is performed in a counterclockwise fashion. Time allotted is 5 minutes, and each successful bite is awarded 10 points. Participants were divided into the novice, intermediate, and experienced groups. Validity evidence based on content, validity evidence based on other variables, and validity evidence based on consequences of testing were assessed.
Seventeen subjects (3 novice, 7 intermediate, and 7 experienced) participated in the study. Validity evidence based on content: The content validity index for realism, relevance, and representativeness was 0.89, 1.00, and 1.00, respectively. Validity evidence based on other variables: The novice, intermediate, and experienced groups scored 30.0 ± 8.2, 57.1 ± 28.1, and 131.2 ± 51.7 (P = .001). Validity evidence based on consequences of testing: The simulator group required 5 ± 5 transoral outlet reduction cases before being able to independently complete an entire purse-string, whereas the non-simulator group required 38 ± 11 clinical cases (P < .0001).
This novel endoscopic suturing simulator seems realistic, relevant, and representative of the clinical suturing experience. In addition, it seems effective at objectively assessing suturing skills and shortening the clinical learning curve.
内镜缝合是一项应用广泛的复杂技术。本研究的目的是开发并验证一种用于荷包缝合模式的新型内镜缝合模拟器及评分系统。
这是一项关于内镜缝合模拟器的前瞻性研究，该模拟器有一个圆形开口，代表Roux-en-Y胃旁路术后扩张的胃空肠吻合口，其圆周周围有12个小靶孔。采用逆时针方式进行荷包缝合。规定时间为5分钟，每次成功咬合得10分。参与者分为新手组、中级组和经验丰富组。评估基于内容的效度证据、基于其他变量的效度证据以及基于测试结果的效度证据。
17名受试者（3名新手、7名中级和7名经验丰富者）参与了研究。基于内容的效度证据：逼真性、相关性和代表性的内容效度指数分别为0.89、1.00和1.00。基于其他变量的效度证据：新手组、中级组和经验丰富组的得分分别为30.0±8.2、57.1±28.1和131.2±51.7（P = 0.001）。基于测试结果的效度证据：模拟器组在能够独立完成整个荷包缝合之前需要5±5例经口缩小出口病例，而非模拟器组需要38±11例临床病例（P < 0.0001）。
这种新型内镜缝合模拟器似乎逼真、相关且具有临床缝合经验的代表性。此外，它似乎能有效客观地评估缝合技能并缩短临床学习曲线。
