虚拟现实腹腔镜模拟器训练在腹腔镜经腹腹膜前疝修补术中应用价值的前瞻性研究

Application value of virtual reality laparoscopic simulator training in laparoscopic transabdominal preperitoneal hernioplasty:a prospective study

目的为探讨虚拟现实腹腔镜模拟器训练在腹腔镜经腹腹膜前疝修补术(TAPP)中的应用价值。方法采用前瞻性队列研究方法。选取2023年7—8月哈尔滨医科大学附属第一医院20名具有≥3年普通外科临床经验且无腹腔镜基础的年轻医师进行培训。采用随机数字表法将学员分为两组,进行虚拟现实腹腔镜模拟器训练的学员为虚拟现实组,进行普通腹腔镜模拟器训练的学员为普通组。两组学员利用各组腹腔镜模拟器,进行为期10d(每项技能训练时间为2h,3项技能小计6h/d)的培训,培训内容为腹腔镜手术基本技能(夹持、剪切以及缝合打结)。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验,组内比较采用配对t检验。偏态分布的计量资料以M(范围)表示计数资料以绝对数表示,组间比较采用χ^(2)检验。结果(1)训练前学员情况。筛选出符合条件的学员20位,男13例,女7例;年龄为31(30~34)岁。10名虚拟现实组学员中,男7例,女3例;年龄为(31.5±1.4)岁;训练前TAPP模拟手术时间为(42±4)min。10名普通组学员中,男6例,女4例;年龄为(31.2±1.0)岁;训练前TAPP模拟手术时间为(42±4)min。两组学员性别、年龄、训练前TAPP模拟手术时间比较,差异均无统计学意义(P>0.05),具有可比性。(2)训练前后学员基本技能情况。虚拟现实组学员训练前夹持评分为(5.1±1.0)分,剪切评分为(4.9±1.0)分,缝合打结评分为(4.7±1.5)分;训练后夹持评分为(8.0±1.3)分,剪切评分为(7.9±1.5)分,缝合打结评分为(6.6±1.3)分,学员训练前后上述指标比较,差异均有统计学意义(t=-5.75,-5.21,-3.07,P<0.05);普通组学员训练前夹持评分为(5.3±1.0)分,剪切评分为(5.0±1.2)分,缝合打结评分为(4.3±1.5)分;训练后夹持评分为(7.1±1.2)分,剪切评分为(6.7±1.3)分,缝合打结评分为(5.7±1.1)分,学员训练前后上述指标比较,差异均有统计学意义(t=-3.73,-3.16,-2.42,P<0.05)。(3)训练前后学员完成模拟手术情况。虚拟现实组学员训练后完成TAPP模拟手术时间为(29±3)min,训练前为(42±4)min,训练前后比较,差异有统计学意义(t=7.69,P<0.05)。普通组学员训练后完成TAPP模拟手术时间为(36±4)min,训练前为(42±4)min,训练前后比较,差异有统计学意义(t=3.75,P<0.05)。虚拟现实组学员训练后完成TAPP模拟手术时间短于普通组学员,两组比较,差异有统计学意义(t=-3.89,P<0.05)。结论虚拟现实腹腔镜模拟器和普通腹腔镜模拟器均能提升学员腹腔镜基本技能以及TAPP模拟手术的熟练程度,且虚拟现实腹腔镜模拟器训练效果更佳。

Objective To investigate the application value of virtual reality laparoscopic simulator training in laparoscopic transabdominal preperitoneal hernioplasty(TAPP).Methods The prospective cohort study was conducted.Twenty young physicians from The First Affiliated Hospital of Harbin Medical University with≥3 years of clinical experience in general surgery and no foundation in laparoscopy were selected for training during July to August 2023.Physicians were divided into two groups based on random number table method.Physicians undergoing virtual reality laparoscopic simulator training were divided into the virtual reality group,and physicians undergoing regular laparoscopic simulator training were divided into the regular group.Two groups of physicians were trained using laparoscopic simulator for 10 days(2 hours for each skill,with a total of 6 hours per day for 3 skills),and the training covered basic laparoscopic surgical skills such as clamping,cutting and suturing and knotting.Measurement data with normal distribution were represented as Mean+SD,and comparison between groups were conducted using the independent sample t test and the paired t test was used for intra group comparison.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups were conducted using the chi-square test.Results(1)Physicians situation before training.A total of 20 physicians were selected for eligibility.There were 13 males and 7 females,aged 31(range,30-34)years.There are 7 males and 3 females in the virtual reality group,with age of(31.5±1.4)years and the TAPP simulation surgery time of(42±4)minutes before training.There are 6 male and 4 female students in the regular group,with age of(31.21.0)years and the TAPP simulation surgery time of(42+4)minutes before training.There was no significant difference in gender,age,TAPP simulation surgery time between the two groups of physicians(P>0.05),confounding bias ensured comparability.(2)Basic skills of physicians before and after training.For physicians in the virtual reality group,the clamping score was 5.1±1.0,the cutting score was 4.9±1.0,the suturing and knotting score was 4.7±1.5 before training.The clamping score was 8.0±1.3,the cutting score was 7.9±1.5,the suturing and knotting score was 6.6±1.3 after training.There were significant differences in the above indicators before and after training(t=-5.75,-5.21,-3.07,P<0.05).For physicians in the regular group,the clamping score was 5.3+1.0,the cutting score was 5.0±1.2,the suturing and knotting score was 4.3±1.5 before training.The clamping score was 7.1±1.2,the cutting score was 6.7±1.3,the suturing and knotting score was 5.7±1.1 after training.There were significant differences in the above indicators before and after training(t=-3.73,-3.16,-2.42,P<0.05).(3)Completion of simulated surgical situations before and after training.The time of completing TAPP simulation surgery for virtual reality group after training was(29±3)minutes,versus(42±4)minutes before training,showing a significant difference before and after training(t=7.69,P<0.05).The time of completing TAPP simulation surgery for regular group after training was(36±4)minutes,versus(42±4)minutes before training,showing a significant difference before and after training(t=3.75,P<0.05).The time of completing TAPP simulation surgery of virtual reality group after training was shorter than that of regular group,showing a significant difference between the two groups(t=-3.89,P<0.05).Conclusion Both of virtual reality and regular laparoscopic simulator can enhance the basic laparoscopic surgical skills and the proficiency of TAPP simulation surgery of physicians,and the training effect of virtual reality laparoscopic simulators is better.