机器人前列腺癌根治术阶梯式培训的应用与思考

Application and Thinking of Stepped Training in Robotic-Assisted Laparoscopic Radical Prostatectomy

机器人辅助腹腔镜前列腺癌根治术(robotic-assisted laparoscopic radical prostatectomy,RARP)的肿瘤学结果、并发症和功能预后与术者的熟练程度和手术技巧相关。熟练的操作与规范的教学培训密不可分。解放军总医院是国内首批引进机器人手术系统的单位,也是国内最早开展RARP的单位,在此术式的临床应用和教学培训方面经验丰富。根据以往的教学经验,制定了不同类型RARP的阶梯式培训计划。首先是常规RARP的规范化手术视频教学,帮助培训人员掌握常规RARP手术基本知识,熟悉手术解剖步骤及注意事项;其次是各种特殊类型RARP手术视频教学,帮助培训人员分析每种类型的手术难点、相应处理措施及并发症预防。再次是机器人模拟器训练,使用daVinci机器人手术系统模拟训练模块进行RARP相关手术技巧的练习,掌握规范操作;然后是动物手术练习,使培训人员感受真实的手术环境以及训练眼、手、脚的配合;最后是临床手术培训,通过担任床旁助手、操作台实际操作,锻炼其不同类型前列腺癌的手术方法及临床应变能力。实践证明,RARP阶梯式手术培训计划是一种可行、有效的培训方法。

The oncological results,complications and functional prognosis of robotic-assisted laparoscopic radical prostatectomy(RARP)are closely related to the surgeon's proficiency and surgical skills.Proficiency and well organized training are inseparable.Chinese PLA General Hospital is one of the first institutions to introduce robotic surgery system in China,and is also the first unit to carry out RARP in China.Researchers have so abundant experience in clinical application as well as teaching and training of RARP.Researchers have built a stepped training program for various types of RARP.The first is the multimedia teaching of ordinary RARP to help the training personnel master the basic knowledge,be familiar with the key points and operation procedure.The second is to analyze the difficult points,tackling measures and precautions of various special types of RARP by means of video teaching.The third is the robotic simulator training to practice surgical skills related to RARP using the daVinci robotic simulation training module.Then is the animal surgery practice to make the trainees have a real feeling and facilitate the cooperation of eyes,hands and feet.Finally,researches have the real patient operation training which includes bedside assistant training and independent operation to help train the operation skills and strain capacity.It has been proved that the stepped training program is a feasible and effective training method.