Alghazawi Laith O K, Mavroveli Stella, Anastasiou Eleni, Attia Mohamed, Johnson Natalie, Campioni-Norman Daniel, Amiras Dimitri, Ladas Andreas, Boland Michael R, Hanna George, Thiruchelvam Paul Tr, Leff Daniel R
Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Breast Unit, Imperial College Healthcare NHS Trust, London, United Kingdom.
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Eur J Surg Oncol. 2025 Jul;51(7):109753. doi: 10.1016/j.ejso.2025.109753. Epub 2025 Mar 7.
Therapeutic Mammoplasty (TM) is increasingly becoming the standard of care, especially for patients with large tumor-to-breast volume ratios. The wider dissemination of oncoplastic skills warrants systems for the acquisition and assessment of safe skills. To date, TM simulations have not been developed for the acquisition or assessment of oncoplastic skills. This study aimed to design, develop, and validate a synthetic TM simulator for specialist surgical training and assessment.
A prospective, observational, and survey-based study. Breast surgeons collaborated with designers to construct a TM simulator. A modified Delphi approach was used to create a Competency Assessment Tool (CAT). Surgeons with varying operative experience performed simulated vertical scar TM. Procedures were videotaped (blinded, pseudo-anonymized), subsequently reviewed, and independently rated against CAT by three experts. Specimen radiographs and volumetric analysis were performed to assess specimen weight(g), volume(cm), and adequacy of resection, derived as a percentage of deviation in uniformity around a 10 mm margin.
Thirty participants were recruited (10 consultants, 10 senior registrars (ST7-8), and 10 junior registrars (ST3-6)). Video-based rating scores (0-40) were significantly greater in consultants (median(IQR) = 34.0(30.5-38.0)) than in senior registrars (median(IQR) = 30.0(28.0-33.0)) and junior registrars (median(IQR) = 28.0(25.8-30.3)). The CAT scores varied significantly based on operator grade (p < 0.05). The inter-rater reliability showed fair agreement (κ = 0.379). Specimens resected by consultants had significantly greater weight and volume (p < 0.05). The consultants demonstrated the greatest uniformity in resection accuracy (p < 0.05).
A novel oncoplastic simulator was developed to practice and assess TM skills. Video-based ratings and end-product assessments differentiated experts from novice surgeons, suggesting construct validity.
治疗性乳房成形术（TM）日益成为标准治疗方法，尤其是对于肿瘤与乳房体积比大的患者。肿瘤整形技术的更广泛传播需要获取和评估安全技能的系统。迄今为止，尚未开发用于获取或评估肿瘤整形技术的TM模拟。本研究旨在设计、开发和验证一种用于专科手术培训和评估的合成TM模拟器。
一项前瞻性、观察性和基于调查的研究。乳腺外科医生与设计师合作构建了一个TM模拟器。采用改良的德尔菲法创建了能力评估工具（CAT）。具有不同手术经验的外科医生进行模拟垂直瘢痕TM手术。手术过程进行录像（ blinded，伪匿名），随后进行回顾，并由三位专家根据CAT进行独立评分。进行标本射线照相和体积分析，以评估标本重量（g）、体积（cm）和切除的充分性，以10mm边缘周围均匀性偏差的百分比表示。
招募了30名参与者（10名顾问医生、10名高级住院医师（ST7 - 8）和10名初级住院医师（ST3 - 6））。基于视频的评分（0 - 40）在顾问医生中（中位数（四分位间距）= 34.0（30.5 - 38.0））显著高于高级住院医师（中位数（四分位间距）= 30.0（28.0 - 33.0））和初级住院医师（中位数（四分位间距）= 28.0（25.8 - 30.3））。CAT评分根据手术医生级别有显著差异（p < 0.05）。评分者间信度显示出中等一致性（κ = 0.379）。顾问医生切除的标本重量和体积显著更大（p < 0.05）。顾问医生在切除准确性方面表现出最大的一致性（p < 0.05）。
开发了一种新型肿瘤整形模拟器来练习和评估TM技术。基于视频的评分和最终产品评估区分了专家和新手外科医生，表明具有结构效度。
Zotero 插件