Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France.
DAICIM Foundation (Training, Research and Clinical Activity in Minimally Invasive Surgery), Buenos Aires, Argentina.
Surg Endosc. 2023 Oct;37(10):8116-8122. doi: 10.1007/s00464-023-10357-7. Epub 2023 Sep 1.
Training programs are essential to introduce new methods for bile duct clearance. Visual examination via cholangioscopy is ideal to diagnose and treat biliary tract diseases such as cancer and choledocholithiasis. However, surgeons rarely use cholangioscopes. Specific training is required to master laparoscopic and percutaneous cholangioscopy. This study aims to assess skill acquisition and retention during cholangioscopy training in the Image-Guided Therapies Masterclass.
This prospective study enrolled 17 physicians undergoing training in interventional treatments of biliary diseases. A novel disposable cholangioscope and access kit were used with a biliary tract model including two simulated common bile duct (CBD) stones. The curriculum required visualization of all critical structures before removal of one stone with a Dormia basket. After informed consent, demographic data and time to exercise completion were recorded on each of two subsequent training days. Task-specific questions were measured at the completion of training using a Likert scale (strongly disagree to strongly agree, 1-5 points).
All participants successfully completed the task (6F/11 M, age 36 ± 5 years; 13 surgeons, 4 interventional radiologists; median experience with percutaneous procedures 2 years, range 0-20). Significant improvement in mean task completion time was observed (day 1: 172 ± 59 s, day 2: 89 ± 45 s; P < 0.0001). All task-specific questions were answered with a median rating of 5/5: "The platform facilitates cholangioscopy" and "This training method accelerates gain in proficiency and is useful for residents/fellows" (IQR 5-5), "This platform is useful to measure the proficiency level" and "There is an application for simulation in percutaneous surgery training" (IQR 4.5-5), "The platform is user-friendly" and "The model quality recreates realistic scenarios" (IQR 4-5).
Cholangioscopic bile duct exploration and stone retrieval were achieved by all participants using a dedicated training program and physical simulator. Significant skill progress was observed during 2 days of dedicated training.
培训计划对于引入新的胆管清除方法至关重要。通过胆管镜检查进行的目视检查是诊断和治疗胆管疾病（如癌症和胆总管结石）的理想方法。然而，外科医生很少使用胆管镜。掌握腹腔镜和经皮胆管镜需要特定的培训。本研究旨在评估在影像引导治疗大师班中进行胆管镜检查培训期间的技能获取和保留情况。
这项前瞻性研究纳入了 17 名接受胆道疾病介入治疗培训的医生。使用一种新型一次性胆管镜和进入套件，以及包括两个模拟胆总管（CBD）结石的胆道模型。课程要求在使用 Dormia 篮取出一颗结石之前，先观察所有关键结构。在获得知情同意后，在随后的两天培训中，每位参与者都记录了人口统计学数据和完成练习的时间。使用李克特量表（从强烈不同意到强烈同意，1-5 分）在培训结束时测量特定任务的问题。
所有参与者均成功完成任务（6 名女性/11 名男性，年龄 36±5 岁；13 名外科医生，4 名介入放射科医生；经皮手术经验中位数为 2 年，范围为 0-20 年）。观察到平均任务完成时间有显著改善（第 1 天：172±59s，第 2 天：89±45s；P<0.0001）。所有特定任务的问题均以中位数 5/5 回答：“该平台有助于胆管镜检查”和“这种培训方法加速了熟练度的提高，对住院医师/研究员有用”（IQR 5-5），“该平台可用于测量熟练程度”和“模拟在经皮手术培训中有应用”（IQR 4.5-5），“该平台易于使用”和“模型质量再现了真实场景”（IQR 4-5）。
所有参与者均使用专用培训计划和物理模拟器成功进行了胆管镜检查和胆管取石。在 2 天的专项培训中观察到了显著的技能进步。
