国产3D腹腔镜用于住院医师进阶整合二段式腹腔镜模拟培训效果分析

Application and practice of domestic 3D laparoscope in the advanced integrated two-stage laparoscopic simulation training course for residents

目的探讨国产3D腹腔镜用于住院医师腹腔镜外科基本技能培训的可行性及效果。方法选择2019年12月至2021年12月在上海交通大学医学院附属瑞金医院接受进阶整合二段式腹腔镜模拟培训一阶段课程的35名外科住院医师作为研究对象。学员分别操作传统2D腹腔镜与国产3D腹腔镜,采用问卷调查法收集学员对于3D腹腔镜的主观感受。培训后评估操作考核结果。结果培训过程中部分学员操作3D腹腔镜会产生一定的眼疲劳及眩晕等视觉不适,但对于3D腹腔镜的总体主观感受无明显不适。3D腹腔镜在纵深感(77.1%)、清晰度(62.9%)、空间定位感(80.0%)等方面明显优于2D腹腔镜。学员分别操作3D腹腔镜和2D腹腔镜完成轨道过弯、穿隧道及高低柱3个模块的考核,在用时[(286.6±215.2)s vs.(302.3±249.2)s,(280.1±157.1)s vs.(306.3±248.4)s,(317.2±130.2)s vs.(342.0±283.7)s]、不规范操作次数[(2.3±1.8)次vs.(2.7±3.3)次,(2.6±2.0)次vs.(3.1±4.3)次,(7.0±3.8)次vs.(6.0±9.5)次]及评分[(3.6±0.9)分vs.(3.5±0.9)分,(3.7±0.9)分vs.(3.6±0.9)分,(3.6±0.9)分vs.(3.7±1.0)分]方面,3D腹腔镜组与2D腹腔镜组的客观考核结果差异无统计学意义(P>0.05)。结论国产3D腹腔镜在腹腔镜外科基本技能培训中有效、可行,学员主观接受程度良好,可以作为在临床工作使用3D腹腔镜前的辅助培训,推进3D腹腔镜的临床应用。

Objective To investigate the feasibility and training effects of a domestically produced 3D laparoscope in basic laparoscopic surgical skills training for residents.Methods A total of 35 surgical residents who received the firststage course of advanced integrated two-stage laparoscopic simulation training in our hospital from December 2019 to December 2021 were prospectively enrolled as the research participants.The trainees operated a conventional 2D laparoscope and a domestic 3D laparoscope respectively.A questionnaire was used to collect their subjective perceptions of 3D laparoscopes.After the training,the operation assessment results of the basic skills training were evaluated.Results The results of the subjective questionnaire showed that the trainees had certain visual discomfort such as eye fatigue and vertigo during the training process for 3D laparoscope,but there was no obvious discomfort in the overall subjective experience of 3D laparoscope.3D laparoscope was significantly better than 2D laparoscope in terms of depth(77.1%),clarity(62.9%),and spatial orientation(80%).The trainees performed 3D and 2D laparoscopes respectively to complete the assessment of three modules:one track transfer,one tunnel pass,and high and low pillars.There was no significant difference between the objective assessment results of the 3D laparoscope group and the 2D laparoscope group in terms of time spent [(286.6±215.2)s vs.(302.3±249.2)s,(280.1±157.1)s vs.(306.3±248.4)s,(317.2±130.2)s vs.(342.0±283.7)s],a number of irregularities(2.3±1.8 vs.2.7±3.3,2.6±2.0 vs.3.1±4.3,7.0±3.8 vs.6.0±9.5)and scores(3.6±0.9 vs.3.5±0.9,3.7±0.9 vs.3.6±0.9,3.6±0.9 vs.3.7±1.0)(P>0.05).Conclusion Domestically produced 3D laparoscopes are effective and feasible in basic laparoscopic surgical skills training,with good subjective acceptance by trainees,and can be used as adjunct training before using 3D laparoscopes in clinical work and promote the clinical application of 3D laparoscopes.