Cizmic Amila, Reichert Paulina, Häberle Frida, Preukschas Anas A, Pianka Frank, Mehrabi Arianeb, Nießen Anna, Müller-Stich Beat P, Hackert Thilo, Grotelüschen Rainer, Nickel Felix
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Surg Endosc. 2025 May;39(5):3285-3297. doi: 10.1007/s00464-025-11701-9. Epub 2025 Apr 14.
Minimally invasive surgery (MIS) is the standard approach in bariatric surgery. The most common bariatric procedures are sleeve gastrectomy and Roux-en-Y-Gastric Bypass (RYGB). Simulation training, including virtual reality (VR), is useful when learning MIS. Training in pairs has proven beneficial in acquiring basic MIS skills. However, this has not been tested on more complex procedures such as MIS RYGB. The study aimed to assess the learning effects of training MIS RYGB on a VR trainer in pairs compared to solo training.
Medical students (n = 60) were randomized into the intervention group, trained in pairs (n = 30), and the control group, trained solo (n = 30). Both groups needed to train MIS RYGB on a VR trainer under the supervision of trained tutors until proficiency was reached. The MIS RYGB proficiency was defined as 105/110 points according to the Bariatric Objective Structured Assessment of Technical Skills (BOSATS) score. The primary outcome was the number of exercise repetitions until proficiency was reached. Secondary outcomes compared the BOSATS scores, bleeding incidents, and the validated score on current motivation.
The intervention group achieved proficiency with significantly fewer repetitions than the control group (p = 0.002). Most participants in the intervention group reached proficiency by the fifth repetition, and none required an eighth repetition. The intervention group had better BOSATS scores than the control group after the second, fourth, and fifth MIS RYGB (91.1 ± 6.4 vs. 87.1 ± 7.0 points, p = 0.025; 104.0 ± 4.7 vs. 100.3 ± 6.1 points, p = 0.014; 106.2 ± 2.8 vs. 101.9 ± 5.8 points, p = 0.026), respectively. Additionally, the intervention group experienced fewer bleeding complications in the fifth and sixth MIS RYGB repetitions than the control group (2 vs. 10, p = 0.001; 0 vs. 8, p < 0.001, respectively).
Training MIS RYGB on a VR trainer in pairs enables trainees to reach procedural proficiency with fewer exercise repetitions than training alone.
微创手术（MIS）是减肥手术的标准方法。最常见的减肥手术是袖状胃切除术和 Roux-en-Y 胃旁路术（RYGB）。包括虚拟现实（VR）在内的模拟训练在学习 MIS 时很有用。双人训练已被证明对掌握基本的 MIS 技能有益。然而，这尚未在诸如 MIS RYGB 等更复杂的手术中得到验证。本研究旨在评估与单人训练相比，双人在 VR 训练器上进行 MIS RYGB 训练的学习效果。
将 60 名医学生随机分为干预组（n = 30），进行双人训练，和对照组（n = 30），进行单人训练。两组都需要在经过培训的导师监督下在 VR 训练器上进行 MIS RYGB 训练，直至达到熟练程度。根据减肥手术技术技能客观结构化评估（BOSATS）评分，MIS RYGB 熟练程度定义为 105/110 分。主要结局是达到熟练程度所需的练习重复次数。次要结局比较了 BOSATS 评分、出血事件以及当前动机的验证评分。
干预组达到熟练程度所需的重复次数明显少于对照组（p = 0.002）。干预组的大多数参与者在第五次重复练习时达到熟练程度，且无人需要第八次重复练习。在第二次、第四次和第五次 MIS RYGB 训练后，干预组的 BOSATS 评分高于对照组（分别为 91.1±6.4 分对 87.1±7.0 分，p = 0.025；104.0±4.7 分对 100.3±6.1 分，p = 0.014；106.2±2.8 分对 101.9±5.8 分，p = 0.026）。此外，在第五次和第六次 MIS RYGB 重复练习中，干预组的出血并发症少于对照组（分别为 2 次对 10 次，p = 0.001；0 次对 8 次，p < 0.001）。
与单独训练相比，双人在 VR 训练器上进行 MIS RYGB 训练能使学员以更少的练习重复次数达到手术熟练程度。
