National Institute of Advanced Industrial Science and Technology (AIST), Health and Medical Research Institute.
Department of Neurosurgery, Kindai University.
Neurol Med Chir (Tokyo). 2024 Nov 15;64(11):395-400. doi: 10.2176/jns-nmc.2024-0080. Epub 2024 Sep 26.
Endoscopic surgery, including endoscopic endonasal transsphenoidal surgery (ETSS), requires special psychomotor skills from surgeons. The learning curve in the acquisition of psychomotor skills varies among individuals, and studies about laparoscopy indicate that the difference can be predicted using spatial ability tests. We examined the association between the results of such tests and the learning curve in ETSS to determine the need for a personalized curriculum for ETSS skill training. A total of 30 fifth-year medical students from Kindai University School of Medicine (17 men, 13 women; mean age, 26 years) without ETSS experience completed the spatial orientation test (SOT) for the measurement of spatial visualization ability. They performed the dural incision task (DIT) twice on an ETSS training model for surgical psychomotor skill evaluation. The SOT scores (angle errors) exhibited substantial individual differences in spatial visualization ability, whereas the DIT scores significantly improved in the second trial (Wilcoxon signed-rank test, P = 0.0035). However, no significant difference was observed in the DIT scores between the smaller error and larger error groups of the SOT. The results indicated that two DIT trials were sufficient to acquire psychomotor skills for the DIT as the endoscope was almost fixed and learning only one viewpoint and line of sight combination was adequate. In conclusion, a personalized ETSS training program based on the trainee's spatial ability is not necessary for the DIT. Further research is warranted to determine the effect of spatial ability on more complex tasks, such as suturing in cranial base repair.
内镜手术，包括经鼻内镜蝶窦手术（ETSS），需要外科医生具备特殊的心理运动技能。个体获得心理运动技能的学习曲线存在差异，而腹腔镜相关研究表明，这种差异可以通过空间能力测试来预测。我们研究了这些测试的结果与 ETSS 学习曲线之间的关联，以确定 ETSS 技能培训是否需要个性化课程。共有 30 名来自日本关西医科大学医学院的五年级医学生（17 名男性，13 名女性；平均年龄 26 岁）没有 ETSS 经验，完成了空间定位测试（SOT）以测量空间可视化能力。他们在 ETSS 技能训练模型上两次进行硬脑膜切开任务（DIT）。SOT 分数（角度误差）在空间可视化能力方面存在显著的个体差异，而 DIT 分数在第二次试验中显著提高（Wilcoxon 符号秩检验，P = 0.0035）。然而，在 SOT 的较小误差和较大误差组之间，DIT 分数没有观察到显著差异。结果表明，两次 DIT 试验足以获得 DIT 的心理运动技能，因为内镜几乎是固定的，仅学习一个视角和视线组合就足够了。总之，基于学员空间能力的个性化 ETSS 培训计划对于 DIT 来说并不是必需的。需要进一步研究来确定空间能力对更复杂任务（如颅底修复中的缝合）的影响。
