3D打印模型在腹腔镜袖状胃切除术止血训练中的应用价值

Application value of 3D printed model in hemostasis training for laparoscopic sleeve gastrectomy

目的探索3D打印模型在腹腔镜袖状胃切除术止血训练中的应用价值。方法采用回顾性描述性研究方法。收集2023年7月浙江省人民医院6名外科医师参与基于3D打印模型的腹腔镜袖状胃切除术止血训练资料;均为男性;年龄为(33.5±9.9)岁。通过水凝胶建立腹腔镜袖状胃切除术3D打印模型模拟术中出血场景,视频记录腹腔镜袖状胃切除术中出血场景下外科医师止血方式和结果。由2位外审专家盲审训练视频并根据客观结构化临床技能评估(OSATS)评分表对网膜游离、血管暴露、血管夹闭及血管夹闭后出血情况进行评分。观察指标:(1)3D打印模型表面效度和内容效度。(2)3D打印模型的有效性验证。正态分布的计量资料以x±s表示。组间比较采用t检验。结果(1)3D打印模型的表面效度和内容效度:6位外科医师对于3D打印模型模拟腹腔镜袖状胃切除术止血训练的整体印象、逼真度、质地、外观、操作空间、触觉相似性评分分别为(4.5±0.6)分、(4.0±0.6)分、(3.7±0.5)分、(4.2±0.8)分、(3.8±0.8)分、(4.2±0.4)分。6位外科医师对于3D打印模型操作与真实场景相似、便于操作、缩短学习曲线和提高操作技能、模型训练可降低患者风险、提升训练者兴趣、提高术者信心、建议推广的评分分别为(4.0±0.6)分、(4.2±0.8)分、(4.3±0.8)分、(4.3±0.5)分、(4.3±0.5)分、(4.0±0.6)分、(4.8±0.4)分。(2)3D打印模型有效性验证:腹腔镜袖状胃切除术中出血场景下外科专家操作OSATS评分和操作时间分别为(18.7±0.6)分和(125±12)s,初级医师上述指标分别为(13.7±1.5)分和(212±51)s,两者比较,差异均有统计学意义(t=5.30,-2.89,P<0.05)。结论3D打印模型应用于腹腔镜袖状胃切除术止血训练可有效模拟术中出血场景,并能区分不同技能级别医师。

Objective To investigate the application value of 3D printed model in hemostasis training for laparoscopic sleeve gastrectomy.Methods The retrospective and descriptive study was conducted.Data were collected from six surgeons who participated in hemostasis training for laparoscopic sleeve gastrectomy using 3D printed model at Zhejiang Provincial People′s Hospital in July 2023.All participants were male,aged(33.5±9.9)years.A 3D printed model simulating bleeding during laparoscopic sleeve gastrectomy was created using hydrogel.Videos were recorded to document the surgeons′hemostasis techniques and outcomes during laparoscopic sleeve gastrectomy.Two external expert reviewers blindly assessed the training videos using the objective structured assess-ment of technical skills(OSATS)scoring system to evaluate mesentery mobilization,vessel exposure,vessel clipping and bleeding after vessel clipping.Observation indicators:(1)face validity and content validity of the 3D printed model;(2)validity verification of the 3D printed model.Measurement data with normal distribution were represented as Mean±SD.Comparison between groups was conducted using the t test.Results(1)Face validity and content validity of the 3D printed model.The surgeons′scores for overall impression,fidelity,texture,appearance,workspace and tactile similarity of the 3D printed model were 4.5±0.6,4.0±0.6,3.7±0.5,4.2±0.8,3.8±0.8 and 4.2±0.4,respectively.The surgeons′scores for similarity to real scenarios,operation convenience,learning curve shortening and operation skills improving,patient risk reduction,trainee′s interest enhancing,confidence increasing and recommendation for promotion were 4.0±0.6,4.2±0.8,4.3±0.8,4.3±0.5,4.3±0.5,4.0±0.6 and 4.8±0.4,respectively.(2)Validity verification of the 3D printed model.The OSATS scores and operation time to treat bleeding during laparoscopic sleeve gastrectomy for expert surgeons were 18.7±0.6 and(125±12)seconds,respectively,versus 13.7±1.5 and(212±51)seconds for junior doctors,showing significant differences between the two groups(t=5.30,-2.89,P<0.05).Conclusion The 3D printed model effectively simulates bleeding scenarios during laparoscopic sleeve gastrectomy and distinguishes between different technical levels of expertise.