三站进阶模式在机器人前列腺癌根治术培训中的应用价值

The application value of three-station advanced model in the training of robot-assisted laparoscopic prostatectomy

目的探讨体外模型+虚拟现实+实际操作三站进阶模式在机器人辅助前列腺癌根治术培训中的应用价值。方法第一站:体外模型训练。受训者在体外模型上进行端端吻合培训,使用Test T、Test R两种不同的评价方法对受训者进行评分。第二站:机器人虚拟现实培训。采用虚拟培训技术培训受训者,评价培训前后指标的变化。第三站:机器人体内操作。受训者与对照组医师进行机器人辅助膀胱尿道吻合,应用膀胱注水试验,评价吻合的可靠性。结果第一站中,6名受训者总体得分显著提高(P=0.004),由训练前的(50.0±10.5)提高至(79.2±9.7);吻合时间明显缩短(P<0.001),由(654.5±24.7)s降至(331.0±36.6)s。第二站中,6名受训者的总体分数显著提高(P<0.001),由训练前的(35.3±3.1)提高至(86.0±4.2);吻合时间显著下降(P<0.001),由(345.5±31.2)s降至(170.0±7.4)s。第三站中,6名受训者在上级医师的指导下均顺利完成膀胱尿道吻合,相比6名对照组医师平均吻合时间由(40.7±8.6)min缩短至(27.5±8.4)min(P=0.023)。在膀胱注水试验中,受训者组未发现吻合口漏水情况,对照组有2例发生漏水情况,由上级医师进行了补救性缝合。结论三站进阶模式能够快速缩短术者机器人前列腺癌根治术学习曲线,有利于在我国有限的机器人设备情况下推广。

Objective To present the application value of a three-station advanced model combining vitro model,virtual reality and practical operation together in the training of robot-assisted laparoscopic prostatectomy.Method The first station:vitro model training.The trainees were asked to practice end to end anastomosis on vitro models,and were graded on both Test T and Test R evaluation criterion.The second station:robot virtual reality training.The virtual reality technology was used and several parameters were evaluated before and after training.The third station:The trainees and urologists in the control group performed robot-assisted vesicourethral anastomosis,and the reliability of the anastomosis was evaluated by bladder affusion test.Results In the first station,the overall scores of six trainees were significantly improved[(50.0±10.5)vs(79.2±9.7),P=0.004]and the anastomosis time was also obviously shortened[(654.5±24.7)s vs(331.0±36.6)s,P<0.001].The overall scores[(35.3±3.1)vs(86.0±4.2),P<0.001]and the anastomosis time[(345.5±31.2)s vs(170.0±7.4)s,P<0.001]of the trainees significantly improved in the second station as well.In the third station,all the 6 trainees successfully accomplished vesicourethral anastomosis under the guidance of superior doctors,and the average anastomosis time was shortened from(40.7±8.6)min to(27.5±8.4)min compared with the control group(P=0.023).In the bladder affusion test,no leakage was found in the trainee group,while leakage occurred in two cases in the control group,and remedial suture was performed by superior doctors.Conclusion The three-station advanced mode could shorten the learning curve of the robot-assisted laparoscopic prostatectomy,which is conducive to the promotion with limited robotic equipment in China.