Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
The Second School of Medicine, Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China.
BMC Med Educ. 2024 Nov 19;24(1):1331. doi: 10.1186/s12909-024-06266-5.
Spaghetti knotting technology is an emerging technique that can reduce the visual field restriction of the operator in laparo-endoscopic single site (LESS) surgery. Multi-directional stitching technology has been proved to improve the accuracy of suturing in clinical application of LESS surgery. Therefore, we conducted a study to evaluate the teaching efficacy and the operation workload of spaghetti knotting technology and conventional knotting technology in LESS suture teaching based on the multi-directional stitching technology.
We selected forty junior residents to learn the skill of knot tying with single-hole laparoscopic simulators. The forty students were randomly and equally divided into control group and experimental group. The control group was trained by the conventional knotting method, and the experimental group was trained by the spaghetti knotting technology. The grades were calculated before and after the training program, including operation score of suturing time, trhead length, needle insertion accuracy, knotting stability, tissue integrity, tissue tightness and the cognitive workload score of mental, physical and temporal demands, performance, effort and frustration.
There was no significant difference between two groups before training. After training, knotting skills and workload were significantly improved. There were significant differences between the two groups in knotting time (p = 0.001), thread length (p = 0.01), and tissue integrity(p = 0.003). The experiment group took less time, left longer thread and had higher tissue integrity. The workload of the experiment group was also accurately reduced. However, there was no significant difference between the two groups in needle insertion accuracy(p = 0.560), knotting stability(p = 0.059), and tissue tightness(p = 0.731).
In LESS suture teaching based on the multi-directional stitching technology, the training of spaghetti knotting techniques significantly improved students' learning efficacy and reduced their workload compared to training conventional knotting techniques. It suggested the combination of spaghetti knotting and multi-directional stitching technology could be a practicable method for laparoscopic skills teaching and a feasible clinical application value on spaghetti knotting technology in LESS surgery.
意大利面条结技术是一种新兴技术，可减少腹腔镜单部位（LESS）手术中操作者的视野限制。多向缝合技术已被证明可提高LESS 手术临床应用中缝合的准确性。因此，我们基于多向缝合技术进行了一项研究，以评估意大利面条结技术和传统结技术在 LESS 缝合教学中的教学效果和手术工作量。
我们选择了 40 名初级住院医师使用单孔腹腔镜模拟器学习打结技能。这 40 名学生被随机平均分为对照组和实验组。对照组采用传统的打结方法进行训练，实验组采用意大利面条结技术进行训练。在培训计划前后计算成绩，包括缝合时间、缝线长度、针插入准确性、结稳定性、组织完整性、组织紧密性以及认知工作量评分，包括心理、体力和时间需求、绩效、努力和挫折感。
两组在训练前无显著差异。训练后，打结技能和工作量均显著提高。在打结时间（p=0.001）、缝线长度（p=0.01）和组织完整性（p=0.003）方面，两组之间存在显著差异。实验组用时更短，留线更长，组织完整性更高。实验组的工作量也得到了准确降低。然而，在针插入准确性（p=0.560）、结稳定性（p=0.059）和组织紧密性（p=0.731）方面，两组之间无显著差异。
在基于多向缝合技术的 LESS 缝合教学中，与传统结技术相比，意大利面条结技术的训练显著提高了学生的学习效果，降低了他们的工作量。这表明意大利面条结技术与多向缝合技术的结合可能是腹腔镜技能教学的一种可行方法，在 LESS 手术中具有可行的临床应用价值。
