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首页> 外文期刊>Surgical Endoscopy >Experimental trial of transvaginal cholecystectomy: an ex vivo analysis of the learning process for a novel single-port technique.
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Experimental trial of transvaginal cholecystectomy: an ex vivo analysis of the learning process for a novel single-port technique.

机译：经阴道胆囊切除术的实验性试验：一种新型单端口技术的学习过程的离体分析。

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BACKGROUND: Interest in natural orifice transluminal endoscopic surgery (NOTES) has expanded, and the first experiences with patients using different techniques have been reported. However, no work has addressed the learning process or the limitations of the procedures. The relation between inexperience and complications became a major concern after the introduction of laparoscopic surgery. This study investigates the learning process for a new technique using specially designed instruments in an ex vivo model before clinical application. METHODS: Specially designed instruments and a single-port technique using the Tuebingen Trainer were used to evaluate instrument and surgeon performance (learning curve) in terms of time and errors. A total of 90 procedures performed by three surgeons were evaluated. Group and individual learning curves were plotted. RESULTS: All the surgeons showed a reduction in both mean cholecystectomy time (subject A: 27.2 vs 16.6 min; subject B: 21.4 vs 19.22 min; subject C: 21 vs 19.7 min) and mean errors (subject A: 2.8 vs 1.6; subject B: 3.5 vs 2.6; subject C: 3.5 vs 2). A plateau was reached after approximately 15 procedures. Group learning curve analysis showed a significant reduction in time between the first group (mean, 24.97 +/- 5.8 min) and last group (mean, 19.30 +/- 3.09 min; F[1,28] = 11.83; p = 0.001) for 15 procedures, as well as reduced technical errors in the fifth group, from 3.7 +/- 1.65 to 1.6 +/- 1.04 (F[1,28] = 8.90; p < 0.01), demonstrating a learning effect. The number of optic and access port position changes were recorded, setting a standard for normal instrument performance. CONCLUSION: This study shows that the tasks of cholecystectomy can be learned safely in a reasonable number of simulations with the new instruments. Although this is a new technique, prior laparoscopic surgery experience is helpful. The technique offers an advantage over those using flexible endoscopes.
机译：背景：对自然孔腔内镜手术（NOTES）的兴趣已经扩大，并且已经报道了使用不同技术的患者的最初经验。但是，没有工作解决学习过程或程序的局限性。腹腔镜手术后，经验和并发症之间的关系成为一个主要问题。这项研究调查了在临床应用之前使用专门设计的仪器在离体模型中学习新技术的过程。方法：使用专门设计的仪器和使用Tuebingen Trainer的单端口技术来评估仪器和外科医生在时间和误差方面的表现（学习曲线）。由三位外科医生进行的总共90道手术进行了评估。绘制小组学习曲线和个人学习曲线。结果：所有外科医生均显示平均胆囊切除时间减少（受试者A：27.2比16.6 min;受试者B：21.4比19.22 min;受试者C：21 vs 19.7 min）和平均误差（受试者A：2.8 vs 1.6;受试者）减少B：3.5对2.6;主题C：3.5对2）。大约15次操作后达到稳定水平。小组学习曲线分析显示，第一组（平均24.97 +/- 5.8分钟）和最后一组（平均19.30 +/- 3.09分钟; F [1,28] = 11.83; p = 0.001）之间的时间显着减少对于15个程序，以及在第五组中减少的技术错误，从3.7 +/- 1.65降低到1.6 +/- 1.04（F [1,28] = 8.90; p <0.01），证明了学习效果。记录了光学元件和进入端口位置变化的次数，为正常仪器性能设定了标准。结论：这项研究表明，使用新仪器通过合理数量的模拟可以安全地学习胆囊切除术的任务。尽管这是一项新技术，但事先的腹腔镜手术经验会有所帮助。与使用柔性内窥镜的技术相比，该技术具有优势。

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