使用硅胶成型心脏模型对先天性心血管外科手术表现和技能保持情况进行纵向评估。
Longitudinal Evaluation of Congenital Cardiovascular Surgical Performance and Skills Retention Using Silicone-Molded Heart Models.
机构信息
Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Center for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada.
出版信息
World J Pediatr Congenit Heart Surg. 2024 May;15(3):332-339. doi: 10.1177/21501351241237785. Epub 2024 Apr 22.
Hands-on surgical training (HOST) for congenital heart surgery (CHS), utilizing silicone-molded models created from 3D-printing of patients' imaging data, was shown to improve surgical skills. However, the impact of repetition and frequency of repetition in retaining skills has not been previously investigated. We aimed to longitudinally evaluate the outcome for HOST on two example procedures of different technical difficulties with repeated attempts over a 15-week period. Five CHS trainees were prospectively recruited. Repair of coarctation of the aorta (CoA) and arterial switch operation (ASO) were selected as example procedures of relatively low and high technical difficulty. Procedural time and technical performance (using procedure-specific assessment tools by the participant, a peer-reviewer, and the proctor) were measured. Coarctation repair performance scores improved after the first repetition but remained unchanged at the follow-up session. Likewise, CoA procedural time showed an early reduction but then remained stable (mean [standard deviation]: 29[14] vs 25[15] vs 23[9] min at 0, 1, and 4 weeks). Conversely, ASO performance scores improved during the first repetitions, but decreased after a longer time delay (>9 weeks). Arterial switch operation procedural time showed modest improvements across simulations but significantly reduced from the first to the last attempt: 119[20] versus 106[28] min at 0 and 15 weeks, = .049. Complex procedures require multiple HOST repetitions, without excessive time delay to maintain long-term skills improvement. Conversely, a single session may be planned for simple procedures to achieve satisfactory medium-term results. Importantly, a consistent reduction in procedural times was recorded, supporting increased surgical efficiency.
利用患者影像数据 3D 打印制作的硅胶模具进行先天性心脏病手术(CHS)的实操训练(HOST)已被证实可以提高手术技能。然而,关于重复训练和重复频率对保留技能的影响尚未被研究过。我们旨在通过 15 周内重复尝试两种不同技术难度的手术,来纵向评估 HOST 的效果。
共前瞻性招募了 5 名 CHS 受训者。选择主动脉缩窄(CoA)修复和动脉调转手术(ASO)作为相对技术难度较低和较高的示例手术。记录手术时间和技术表现(参与者、同行评审者和指导者使用特定手术的评估工具)。
第一次重复后,CoA 修复的手术表现评分提高,但在随访时没有变化。同样,CoA 的手术时间也出现了早期缩短,但随后保持稳定(0、1 和 4 周时分别为 29[14]、25[15]和 23[9]分钟)。相反,ASO 的手术表现评分在第一次重复时提高,但在较长时间延迟(>9 周)后下降。动脉调转手术的手术时间在模拟中略有改善,但从第一次到最后一次尝试明显减少:0 和 15 周时分别为 119[20]和 106[28]分钟,= 0.049。
复杂的手术需要多次 HOST 重复,且无过长的时间延迟,以维持长期技能提高。相反,单次模拟可以用于简单的手术,以达到满意的中期效果。重要的是,手术时间呈持续下降趋势,这支持了手术效率的提高。