目的 探讨基于临床真实场景的新型显微外科模拟训练平台的有效性。 方法 该研究为前瞻性研究，2020年1月1日至2023年1月1日选取解放军总医院第一医学中心整形修复科和中国医学科学院整形外科医院在读硕士研究生为受训对象，给予基于临床真实场景的新型显微外科模拟培训。该训练平台由研究小组设计，装置构成包括：(1)血液灌注系统，用于模拟活体动物血管；(2)内限制挡杆系统，用于模拟在深部腔隙中操作；(3)外限制挡杆系统，用于模拟困难体位下的操作；(4)蠕动平台系统，用于模拟呼吸运动影响下的显微操作。将受训者完全随机分配入对照组(传统显微外科进阶训练组)和实验组(使用该模拟训练装置进行进阶训练)。经过4周的显微外科培训，受训者被安排进行2次操作技能考核，第1次考核使用活体动物模型，进行鼠尾动脉的端对端吻合，第2次考核在真实病例中进行游离背阔肌肌皮瓣动脉的端对端吻合。采用显微外科GRS评分量表和手术时间作为评价指标比较2组的显微外科技能训练效果。GRS评分量表包括灵活性、视觉空间能力、手术流畅程度、判断力4项，评分越高表明该项技能掌握越好。卡方检验分析2组受训者性别的差异。采用Mann－Whitney U检验比较2组的GRS分数，采用独立t检验分析2组受训者年龄、手术时间。P<0.05为差异统计学意义。 结果 共纳入18名受训者，其中对照组10名，男6名，女4名，年龄(27.80±1.87)岁；实验组8名，男4名，女4名，年龄(28.10±1.56)岁。2组受训者的年龄、性别分别比较，差异均无统计学意义(P均>0.05)。在第1次(活体动物模型)考核中，对照组和实验组的GRS量表各项目评分、手术时间差异均无统计学意义(P均>0.05)。但在第2次(真实病例)考核中，实验组的GRS量表各项目评分明显高于对照组，实验组手术时长较对照组更短，差异均具有统计学意义(P均<0.05)。 结论 与传统的显微外科培训方法相比，使用基于临床真实场景的新型显微外科培训平台进行显微操作训练，可以有效缩短学习曲线，使受训者更快地掌握复杂的显微操作技能。 Objective A microsurgical simulation training device based on real clinical scenes was designed and its effectiveness was tested. Methods From January 1, 2020 to January 1, 2023, postgraduate students in the Plastic and Reconstructive Surgery Department of the First Medical Center of PLA General Hospital and the Plastic Surgery Hospital of Chinese Academy of Medical Sciences were enrolled in this prospective study. The simulation training device consists of four parts: (1)Blood perfusion system, which is used to simulate living animal blood vessels.(2)The inner baffling rod system, which is used to simulate the operation in deep cavity.(3) The exterior baffling rod system, which is used to simulate the operation in difficult positions.(4) A pulsating platform system is used to simulate microsurgery under the influence of respiratory movement. Preliminary verification of the effect of the simulated training device was as follows: Surgeons with no experience in microsurgery were completely randomized assigned to the control group (traditional microsurgery training group) and the experimental group (training group using the simulated training device). After 4 weeks of microsurgical training, the trainees were assigned to perform two surgical skill assessments, the first using a live animal model for end-to-end anastomosis of rat tail arteries, and the second assessment using end-to-end anastomosis of free latissimus dorsi flap arteries in a real case. The performance of the two groups was compared by using operation time and microsurgical GRS score scale including four items of dexterity, visuospatial ability, operative flow and judgment. Chi-squared test was used to analyze gender between the two groups. GRS scores between the two groups were compared by the Mann-Whitney U test. Participants’ ageand operation time between the two groups was compared by independent t-test. P<0.05 was considered statistically significant. Results A total of 18 trainees were enrolled, including 10 in the control group, 6 males and 4 females, with an average age of (27.80±1.87) years. There were 8 subjects in the experimental group, 4 males and 4 females, with an average age of (28.10±1.56) years old. There were no significant differences in age, gender and other baseline characteristics between the two groups (P>0.05). There was no significant difference in GRS score and operation time between the control group and the experimental group (P> 0.05) in the first assessment. However, in the second assessment of real cases, the GRS score of the experimental group was significantly higher than that of the control group(14.25 vs. 5.70), and the operation duration of the experimental group was also shorter than that of the control group, and the difference was statistically significant[(100.37±24.65 ) min vs. (105.60±22.84) min] (P<0.05). Conclusion Compared with traditional microsurgery training methods, using microsurgery training devices based on clinical real scenes can effectively shorten the learning curve and enable trainees to master complex micromanipulation skills more quickly.
Preliminary teaching application of a new microsurgery simulation training platform based on real clinical scenarios
Objective A microsurgical simulation training device based on real clinical scenes was designed and its effectiveness was tested. Methods From January 1, 2020 to January 1, 2023, postgraduate students in the Plastic and Reconstructive Surgery Department of the First Medical Center of PLA General Hospital and the Plastic Surgery Hospital of Chinese Academy of Medical Sciences were enrolled in this prospective study. The simulation training device consists of four parts: (1)Blood perfusion system, which is used to simulate living animal blood vessels.(2)The inner baffling rod system, which is used to simulate the operation in deep cavity.(3) The exterior baffling rod system, which is used to simulate the operation in difficult positions.(4) A pulsating platform system is used to simulate microsurgery under the influence of respiratory movement. Preliminary verification of the effect of the simulated training device was as follows: Surgeons with no experience in microsurgery were completely randomized assigned to the control group (traditional microsurgery training group) and the experimental group (training group using the simulated training device). After 4 weeks of microsurgical training, the trainees were assigned to perform two surgical skill assessments, the first using a live animal model for end-to-end anastomosis of rat tail arteries, and the second assessment using end-to-end anastomosis of free latissimus dorsi flap arteries in a real case. The performance of the two groups was compared by using operation time and microsurgical GRS score scale including four items of dexterity, visuospatial ability, operative flow and judgment. Chi-squared test was used to analyze gender between the two groups. GRS scores between the two groups were compared by the Mann-Whitney U test. Participants’ ageand operation time between the two groups was compared by independent t-test. P<0.05 was considered statistically significant. Results A total of 18 trainees were enrolled, including 10 in the control group, 6 males and 4 females, with an average age of (27.80±1.87) years. There were 8 subjects in the experimental group, 4 males and 4 females, with an average age of (28.10±1.56) years old. There were no significant differences in age, gender and other baseline characteristics between the two groups (P>0.05). There was no significant difference in GRS score and operation time between the control group and the experimental group (P> 0.05) in the first assessment. However, in the second assessment of real cases, the GRS score of the experimental group was significantly higher than that of the control group(14.25 vs. 5.70), and the operation duration of the experimental group was also shorter than that of the control group, and the difference was statistically significant[(100.37±24.65 ) min vs. (105.60±22.84) min] (P<0.05). Conclusion Compared with traditional microsurgery training methods, using microsurgery training devices based on clinical real scenes can effectively shorten the learning curve and enable trainees to master complex micromanipulation skills more quickly.
万方数据
