Geissler Mark Enrik, Bereuter Jean-Paul, Geissler Rona Berit, Kowalewski Karl-Friedrich, Egen Luisa, Haney Caelan, Schmidt Sofia, Fries Alexa, Buck Nathalie, Weiß Juliane, Krause-Jüttler Grit, Weitz Jürgen, Distler Marius, Oehme Florian, von Bechtolsheim Felix
Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Surg Endosc. 2025 Mar;39(3):2016-2025. doi: 10.1007/s00464-025-11531-9. Epub 2025 Jan 30.
Simulator training is an efficient method for the development of basic laparoscopic skills. We aimed to investigate if low-cost simulators are comparable to more expensive box trainers regarding surgeons usability, likability, and performance.
This multi-center, randomized crossover study included 16 medical students, seven abdominal surgeons, and seven urological surgeons. Participants performed four laparoscopic tasks (peg transfer, circle cutting, balloon resection, suture and knot) on both, a "Low cost trainer" (LCT) or a "high cost trainer" (HCT) in a randomized order. The primary endpoint was the subjective rating of both training simulators in terms of camera view, depth perception, movement of instruments, pricing, and usability for training. Secondary endpoints were force parameters, task completion time, surgical errors, and psychological workload.
Participants rated the LCT better concerning view (p < 0.001), depth perception (p = 0.003), pricing (p < 0.001), and usability for digital training (p < 0.001), but worse in terms of instrument movement (p = 0.004). Overall, the LCT was rated better than the HCT (p = 0.015). Regarding force parameters, participants showed a significantly lower force exertion on the HCT during the peg transfer task (p = 0.008). The force exertion in the other tasks were comparable between both trainers. Participants were significantly faster using the HCT during the peg transfer (p = 0.049) and significantly slower in balloon resection (p = 0.049) and suture and knot task (p = 0.026). The assessment of the participants' workload showed no differences.
The LCT was generally rated better than the HCT. The differences concerning force exertion and task completion time showed better results during peg transfer at the HCT but were generally inconclusive and without systemic advantage for either trainer. However, the LCT could be a promising and cost-effective augmentation for modern laparoscopic training.
模拟训练是培养基本腹腔镜技能的有效方法。我们旨在研究低成本模拟器在外科技巧的可用性、喜爱度和表现方面是否与更昂贵的箱式训练器相当。
这项多中心随机交叉研究纳入了16名医学生、7名腹部外科医生和7名泌尿外科医生。参与者以随机顺序在“低成本训练器”（LCT）和“高成本训练器”（HCT）上执行四项腹腔镜任务（移钉、环切、球囊切除、缝合打结）。主要终点是对两种训练模拟器在视野、深度感知、器械移动、价格和训练可用性方面的主观评分。次要终点是力参数、任务完成时间、手术失误和心理负荷。
参与者对LCT在视野（p < 0.001）、深度感知（p = 0.003）、价格（p < 0.001）和数字训练可用性（p < 0.001）方面的评价更高，但在器械移动方面较差（p = 0.004）。总体而言，LCT的评分高于HCT（p = 0.015）。关于力参数，参与者在移钉任务中在HCT上的用力明显更低（p = 0.008）。其他任务中的用力在两种训练器之间相当。参与者在使用HCT进行移钉时明显更快（p = 0.049），在球囊切除（p = 0.049）以及缝合打结任务中明显更慢（p = 0.026）。对参与者负荷的评估未显示差异。
LCT的总体评分高于HCT。在用力和任务完成时间方面的差异表明，HCT在移钉时效果更好，但总体而言尚无定论，且两种训练器均无系统性优势。然而，LCT可能是现代腹腔镜训练中一种有前景且具成本效益的补充方式。
