多维度腹腔镜缝合技能培训体系在腹腔镜胰腺手术推广中的作用

Multidimensional model of laparoscopic suturing training for laparoscopic pancreatic surgery

目的探究多维度腹腔镜缝合技能培训体系在腹腔镜胰腺手术推广中的作用。方法选取2018年9月至2020年3月在浙江省人民医院胃肠胰外科进修并参加培训的医师作为研究对象,对其进行理论学习、缝合技能培训和考核、临床实践等多维度培训。应用LAP Mentor腹腔镜高级模拟机中"褥式缝合"模块作为初始评估及培训后考核。将LAP Mentor提供的每针调针时间、打结时间、总时间、有效定点缝合针数比例、激进牵拉组织次数等作为考核指标,并随访受训医师进修结束后新开展手术情况。结果共培训进修医师13人,其中副主任医师4人,3年以上主治医师7人,3年以下主治医师2人。受训者均仅有初级腹腔镜手术经验,无腹腔镜胰腺手术经验。经培训后,每针调针时间从(93.6±31.6)s缩短至(45.7±13.6)s,打结时间从(138.9±46.2)s缩短至(62.1±22.9)s,总时间从(15.9±3.8)min缩短至(6.7±3.5)min,有效定点缝合针数比例从(63.7±10.3)%升高至(89.6±9.8)%,激进牵拉组织次数从(18.2±12.5)次降低至(6.7±4.9)次,差异均具有统计学意义(P<0.05)。培训后随访,所有受训者对开展腹腔镜胰腺手术充满信心。1位受训者已独立完成首例腹腔镜胰十二指肠切除术,1位受训者可独立完成腹腔镜保留脾脏胰体尾切除术时脾静脉分支缝合止血,3位受训者作为助手完成腹腔镜胰十二指肠切除术。结论多维度腹腔镜缝合技能培训可以提升受训者的缝合技能,提高其信心,有助于腹腔镜胰腺手术推广普及。

Objective To evaluate the effect of multidimensional model of laparoscopic suture training in spread of laparoscopic pancreatic surgery.Methods The surgeons who took advanced training in Department of Gastroenterology and Pancreatic Surgery in Zhejiang Provincial People’s Hospital from September 2018 to March 2020 were enrolled.Theoretical presentation,simulation training and assessment,clinical practices were included in the multidimensional training model.The"mattress suture"module(2 mattress sutures)in the LAP Mentor laparoscopic advanced simulator was used as the initial assessment and post-training assessment.The average needle loading time,time to form a knot,total time,accuracy rate of precise needle passage through the entrance and exit dots,and total aggressive tissue handing provided in the LAP Mentor were analyzed pre-and post-training.The trained surgeons were followed up for their clinical work in own hospitals.Results A total of 13 surgeons were trained,including 4 deputy chief physicians,7 attending physicians over 3 years,and 2 attending physicians under 3 years.The trainees had only primary laparoscopic surgery experience and no laparoscopic pancreatic surgery experience.After training in the above scheme,the average needle loading time was shortened from(93.6±31.6)s to(45.7±13.6)s,and the time to form a knot was reduced from(138.9±46.2)s to(62.1±22.9)s,and total time to accomplish the suture shortened from(15.9±3.8)min to(6.7±3.5)min.The accuracy rate of precise needle passage through the entrance and exit dots increased from(63.7±10.3)% to(89.6±9.8)%.The total aggressive tissue handing decreased from(18.2±12.5)to(6.7±4.9).All those data showed statistical differences(P<0.05).During follow-up,all traineescan operate the laparoscopic pancreatic surgery proficiently.One trainee completed his first laparoscopic pancreaticoduodenctomy as the primary surgeon,and one trainee complete the splenic vein branch suture to stop hemostasis during laparoscopic pancreatectomy with spleen-preserving spleen,and 3 trainees completed laparoscopic pancreaticoduodenctomy as the first assistant surgeons with good outcomes.Conclusion Multidimensional model of laparoscopic suture training can improve the trainee's suture skill and help perform complex laparoscopic pancreatic surgery with self-confidence.