基于虚拟现实技术的腹腔镜模拟操作训练与传统训练在小儿泌尿微创手术教学中的应用对比

A comparative study of virtual-reality based laparoscopic training simulators with traditional training strategy in pediatric minimally invasive surgery training program

目的:比较基于虚拟现实技术的腹腔镜模拟操作训练与传统训练在小儿泌尿微创手术教学中的应用效果。方法:回顾性分析2020年9月至2023年9月在上海交通大学医学院附属瑞金医院(传统组)及中国人民解放军总医院第七医学中心(混合组)参加小儿泌尿外科微创技术培训的学员参训数据,共24名学员纳入研究,其中传统组10名,混合组14名,均无腹腔镜主刀手术经验。传统组全程以传统腹腔镜训练模拟器进行训练,混合组采用传统腹腔镜结合LapSim虚拟现实技术进行训练。比较两组学员基线数据、项目结业考核手术操作及患者围术期数据,手术操作视频评分参考整体腹腔镜技能评分表(GOALS),由同一位考官进行评估。统计学方法采用t检验、卡方检验和Fisher精确检验。结果:两组学员的年龄、性别、学历、职称比较差异均无统计学意义(P值分别为0.576、1.000、1.000、0.615)。两组参加培训项目时长均为3个月(其中48学时操作训练)。考核手术为腹腔镜下睾丸下降固定术,两组平均手术时间、患儿术后1周超声情况比较差异均无统计学意义(P值分别为0.070、0.417);两组学员GOALS评分传统组平均为(16.4±1.3)分,混合组平均为(17.9±1.0)分,差异有统计学意义(t=3.312,P=0.003);两组GOALS评分分项双手协调性、操作效率、组织损伤控制、独立完成手术能力比较差异无统计学意义(P值分别为0.636、0.862、0.089、0.278);传统组深度感知评分平均为(3.2±0.6)分,混合组平均为(3.8±0.7)分,两组比较差异有统计学意义(t=2.103,P=0.047)。结论:综合利用传统腹腔镜训练模拟器结合虚拟现实模拟操作训练可以更加高效地进行儿童泌尿外科微创技术训练,具有一定的临床推广意义。

Objective:To compare the application effects of virtual-reality based laparoscopic training simulators versus traditional training strategy in pediatric minimaly invasive surgery training program.Methods:We retrospectively analyzed the training data of trainees who participated in the pediatric urology minimally invasive program in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine(traditional group)and the Seventh Medical Center of PLA General Hospital(hybrid group)from September 2020 to September 2023.A total of 24 trainees were included in this study,including 10 in the traditional group and 14 in the hybrid group.None of the trainees had experience in laparoscopy.The traditional group were trained with the traditional laparoscopic simulator while the hybrid group were trained with the traditional laparoscopic simulator combined with LapSim virtual-reality tech nique.The trainees'baseline data,project completion assessment and perioperative data of the patients in the two groups were compared.The operation videos were scored by the same surgeon according to the global overall laparoscopic skills scoring scale(GOALS).Results:There were no statistically significant differences between the two groups in terms of age,gender,education,and title(P=0.576,1.000,1.000,0.615,respectively).All trainees participated the 3 months training program(including 48 hours of laparoscopic training).The examination surgery was laparoscopic orchiopexy.The average time of intra-abdominal operation time and the results of ultrasound had no significant differences between the two groups(P=0.070,0.417,respectively).The average GOALS scores of the trainees in the traditional group was 16.4±1.26,and 16.4±1.26 in the hybrid group,with significant difference(t=3.312,P=0.003).There had no significant differences in the subgroups of GOALS score such as both hands coordination,operation efficiency,tissue injury control,and independent performance between the two groups(P=O.636,0.862,0.089,0.278,respectively),but there was a significant difference in depth perception between traditional group(3.20±0.63)and hybrid group(3.79±0.70,t=2.103,P=0.047).Conclusion:Combined the traditional laparoscopic training simulator with virtual reality laparoscopic simulator can be more efficiency of minimally invasive surgical training in pediatric urology and holds significant clinical value for broader implementation.