Kaimi Pegi, Fisher David M, Yasabala Branavan, Wong Riff Karen W, Podolsky Dale J
Faculty of Dentistry, The University of Toronto, Toronto, Ontario, Canada.
Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Plast Reconstr Aesthet Surg. 2025 Apr;103:102-113. doi: 10.1016/j.bjps.2025.01.040. Epub 2025 Jan 30.
Cleft lip repair is a challenging procedure with a steep learning curve. A cleft lip simulator can augment the operating experience to shorten the learning curve. This study evaluated the efficacy of a high-fidelity cleft lip simulator using a newly developed cleft lip technical assessment tool.
Four plastic surgery residents and 6 fellows performed 3 sequential cleft lip repairs. Three staff surgeons performed 1 cleft lip repair. Each procedure was video recorded and assessed by 3 staff cleft surgeons using a newly developed cleft lip technical assessment scale and a previously developed global rating scale. The reliability (intraclass correlation coefficient [ICC]) of the assessment scores was determined. The first simulation session was compared among participants to determine whether the scales and simulator could distinguish between skill level. Learning curves were determined using successive assessment scores among the trainees.
The average ICC for the cleft lip-specific and global scores were 0.72 (range 0.65-0.82) and 0.70 (range 0.60-0.79), respectively. All scale items demonstrated statistically significant interrater reliability. The staff surgeons significantly outperformed the trainees in the first simulation session for both assessment scores (p < 0.05). The trainees demonstrated improved performance after each session.
A cleft lip assessment scale was developed and found to be reliable at evaluating technical skill in simulated cleft lip repair. Repeated use of the cleft lip simulator improved performance in simulated cleft lip repair.
唇裂修复手术具有挑战性，学习曲线较陡。唇裂模拟器可以增加手术经验以缩短学习曲线。本研究使用一种新开发的唇裂技术评估工具评估了高保真唇裂模拟器的效果。
四名整形外科住院医师和六名进修医师依次进行了三次唇裂修复手术。三名主治外科医生进行了一次唇裂修复手术。每次手术均进行视频记录，并由三名唇裂主治外科医生使用新开发的唇裂技术评估量表和先前开发的整体评分量表进行评估。确定评估分数的可靠性（组内相关系数[ICC]）。比较参与者之间的第一次模拟手术，以确定量表和模拟器是否能够区分技能水平。使用学员的连续评估分数确定学习曲线。
唇裂特异性评分和整体评分的平均ICC分别为0.72（范围0.65 - 0.82）和0.70（范围0.60 - 0.79）。所有量表项目均显示出具有统计学意义的评分者间可靠性。在第一次模拟手术中，主治外科医生在两项评估分数上均显著优于学员（p < 0.05）。学员在每次手术后表现有所改善。
开发了一种唇裂评估量表，发现其在评估模拟唇裂修复技术技能方面具有可靠性。重复使用唇裂模拟器可提高模拟唇裂修复的表现。
